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Book Details
Abstract
Editor Peter Mazzaglia and authors review the current management and procedures in endocrine surgery. Articles will cover: central compartment lymph node dissection for papillary thyroid cancer; evaluation of thyroid incidentaloma; the role of genetic markers in the evaluation and management of thyroid nodules; medical therapy for advanced forms of thyroid cancer; follicular lesions of the thyroid; controversy over radio-iodine ablation: who benefits?; minimizing cost while maximizing success in the pre-operative localization strategy for primary hyperparathyroidism; operative treatment for primary hyperparathyroidism; evaluation of adrenal incidentalomas: biochemical and radiographic characterization; hyperaldosteronism: diagnosis, lateralization, and treatment; subclinical Cushing’s syndrome; adrenocortical cancer update; and pancreatic neuroendocrine tumors.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Endocrine Surgery | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Surgical Clinics\rOf North America\r | xi | ||
| Foreword\r | xiii | ||
| Preface\r | xv | ||
| Evaluation of Thyroid Incidentaloma | 485 | ||
| Key points | 485 | ||
| Introduction | 485 | ||
| Detection of incidental thyroid nodules | 486 | ||
| CT scan detection of incidental thyroid nodules | 486 | ||
| Case Presentation | 486 | ||
| PET scan detection of incidental thyroid nodules | 489 | ||
| Case Presentation | 489 | ||
| Neck U/S and carotid duplex scan detection of incidental thyroid nodules | 490 | ||
| The role of the incidental thyroid nodule in the rising incidence of thyroid cancer | 493 | ||
| Summary | 495 | ||
| References | 495 | ||
| Follicular Lesions of the Thyroid | 499 | ||
| Key points | 499 | ||
| Introduction | 499 | ||
| Clinical presentation | 500 | ||
| Preoperative diagnosis | 500 | ||
| Ultrasonography | 500 | ||
| Fine-Needle Aspiration | 501 | ||
| Molecular Markers | 502 | ||
| Pathologic diagnosis | 503 | ||
| Follicular Adenoma and Carcinoma | 503 | ||
| Follicular Variant of Papillary Cancer | 503 | ||
| Differential diagnosis | 505 | ||
| Treatment | 506 | ||
| Surgical Management | 506 | ||
| Role of Intraoperative Frozen Section | 506 | ||
| Radioactive Iodine | 507 | ||
| Follow-Up | 507 | ||
| Prognosis | 507 | ||
| Tumor histology | 508 | ||
| MIFC | 508 | ||
| WIFC | 509 | ||
| FVPTC | 509 | ||
| Summary | 509 | ||
| References | 509 | ||
| The Role of Genetic Markers in the Evaluation and Management of Thyroid Nodules | 515 | ||
| Key points | 515 | ||
| Introduction | 515 | ||
| Background | 516 | ||
| Currently available techniques | 516 | ||
| Gene expression profiling | 517 | ||
| Available Gene Expression Profiling Tests | 517 | ||
| Which Patients Should Be Considered for Afirma Testing? | 518 | ||
| Which Patients Should Not Undergo Afirma Testing? | 519 | ||
| Timing and Details of Sample Collection for Afirma Testing | 519 | ||
| Mutational panels | 520 | ||
| BRAF Mutations | 521 | ||
| RAS Oncogenes | 522 | ||
| Rearrangment during transfection/PTC proto-oncogene rearrangements | 522 | ||
| PAX8/PPARG rearrangements | 522 | ||
| Telomerase reverse transcriptase promoter mutations | 522 | ||
| Available mutational panel tests | 522 | ||
| Which Patients Should Be Considered for Mutational Testing? | 523 | ||
| Which Patients Should Not Get Mutational Testing? | 523 | ||
| Timing and Details of Sample Collection for Mutational Testing | 523 | ||
| Discussion | 524 | ||
| Cost-effectiveness | 525 | ||
| Future direction | 525 | ||
| References | 526 | ||
| Prophylactic Central Compartment Neck Dissection for Papillary Thyroid Cancer | 529 | ||
| Key points | 529 | ||
| Introduction | 529 | ||
| Lymph node metastases in patients with papillary thyroid cancer | 531 | ||
| Central compartment recurrence for clinically node-negative PTC with or without pCCND | 532 | ||
| Effect of pCCND on postoperative serum thyroglobulin levels and radioiodine uptake | 533 | ||
| Effect of pCCND on indications for radioiodine ablation and dosing of 131I | 533 | ||
| Morbidity of CCND | 534 | ||
| Summary | 535 | ||
| References | 535 | ||
| Medical Therapy for Advanced Forms of Thyroid Cancer | 541 | ||
| Key points | 541 | ||
| Introduction | 541 | ||
| Historical overview | 542 | ||
| Medical therapy for advanced DTC | 545 | ||
| Targets and Mechanisms | 545 | ||
| Therapeutic Agents | 555 | ||
| Medical therapy for advanced MTC | 559 | ||
| Targets and Mechanisms | 560 | ||
| Therapeutic Agents | 560 | ||
| Medical therapy for ATC | 561 | ||
| Targets and Mechanisms | 561 | ||
| Therapeutic Agents | 561 | ||
| Innovative studies in prospective drugs | 562 | ||
| Advanced DTC and MTC | 562 | ||
| ATC | 563 | ||
| Algorithm for management: targeted therapy for thyroid cancer | 563 | ||
| Advanced DTC | 563 | ||
| MTC | 563 | ||
| ATC | 564 | ||
| Efficacy of medical therapy for advanced thyroid cancer | 564 | ||
| Summary | 565 | ||
| References | 565 | ||
| Controversy Over Radioiodine Ablation In Thyroid Cancer | 573 | ||
| Key points | 573 | ||
| Introduction | 573 | ||
| Epidemiology | 574 | ||
| Overdiagnosis | 575 | ||
| Extent of surgery | 576 | ||
| Advantages of radioiodine treatment | 577 | ||
| Recent guidelines | 577 | ||
| Who benefits? | 578 | ||
| High-Risk Patients | 578 | ||
| Lack of Benefit for Low-risk Patients | 579 | ||
| Patients Who May Benefit from Radioiodine Treatment: Intermediate-Risk | 579 | ||
| Changing approaches to radioiodine therapy | 580 | ||
| The role of preablation, diagnostic whole-body scans | 581 | ||
| Side effects and risk of secondary malignancy | 582 | ||
| Summary | 582 | ||
| References | 583 | ||
| Minimizing Cost and Maximizing Success in the Preoperative Localization Strategy for Primary Hyperparathyroidism | 587 | ||
| Key points | 587 | ||
| Introduction | 587 | ||
| Parathyroid Embryology and Anatomy As It Relates to Imaging Interpretation | 588 | ||
| Superior parathyroid anatomic and imaging location | 588 | ||
| Inferior parathyroid anatomic and imaging location | 589 | ||
| US | 589 | ||
| Typical US Appearance and Location of Parathyroid Adenomas | 591 | ||
| Accuracy of US | 591 | ||
| Cost-Effectiveness of US | 592 | ||
| MIBI | 593 | ||
| Choosing the Appropriate Scintigraphy Study | 596 | ||
| Accuracy and Cost-Effectiveness of Scintigraphy | 596 | ||
| 4DCT | 597 | ||
| Accuracy of 4DCT | 598 | ||
| Cost-Effectiveness of 4DCT | 598 | ||
| Other Considerations Regarding 4DCT | 598 | ||
| Differential jugular venous sampling | 599 | ||
| Summary and recommendations | 600 | ||
| References | 602 | ||
| Operative Treatment of Primary Hyperparathyroidism | 607 | ||
| Key points | 607 | ||
| Introduction | 608 | ||
| The arguments in favor of routine 4-gland exploration | 609 | ||
| Learn from History or Be Doomed to Repeat It | 609 | ||
| Four-gland Exploration May Yield the Highest Long-term Cure Rate | 610 | ||
| Four-gland Exploration Is a Low-risk, Safe Operation | 611 | ||
| Reoperation Has a Lower Cure Rate and Higher Complication Rate Than Initial Surgery | 611 | ||
| Four-gland Exploration Is Mandatory in Patients with High Risk of Multigland Disease | 611 | ||
| Preoperative Localization Studies and Their Costs Are Not Necessary Before 4-Gland Exploration | 612 | ||
| Intraoperative Adjuncts, Including IOPTH, Are Not Necessary in 4-Gland Exploration | 612 | ||
| Depending on the Time Required for IOPTH, 4-Gland Exploration May Be Faster | 612 | ||
| Summary of the arguments in favor of routine 4-gland exploration | 613 | ||
| The arguments in favor of focused parathyroidectomy | 613 | ||
| Focused Parathyroidectomy and 4-Gland Exploration Have Similar Cure Rates | 613 | ||
| Focused Parathyroidectomy Is Less Costly Than 4-Gland Exploration | 614 | ||
| Focused Parathyroidectomy May Have Lower Complication Rates Than 4-Gland Exploration | 615 | ||
| Focused Parathyroidectomy Should Be Faster Than 4-Gland Exploration | 615 | ||
| Focused Parathyroidectomy Is Associated with Less Patient Discomfort | 615 | ||
| A Policy of Routine Bilateral Exploration Is Equivalent to Performing Unnecessary Dissection 95% of the Time | 616 | ||
| Summary of the arguments in favor of focused parathyroid exploration | 616 | ||
| Summary | 617 | ||
| References | 618 | ||
| Radiographic Evaluation of Nonfunctioning Adrenal Neoplasms | 625 | ||
| Key points | 625 | ||
| Adrenal incidentaloma and rates of adrenocortical carcinoma | 625 | ||
| Initial radiographic presentation | 627 | ||
| Adrenal CT | 628 | ||
| Adrenal MRI | 628 | ||
| CT washout techniques | 630 | ||
| PET scan | 632 | ||
| Imaging characteristics of individual lesions | 632 | ||
| Myelolipoma | 633 | ||
| Cyst | 633 | ||
| Hemorrhage | 633 | ||
| Adrenocortical Cancer | 634 | ||
| Patients with a Known Nonadrenal Malignancy | 636 | ||
| Adrenal metastases | 636 | ||
| Protocol for radiographic workup | 636 | ||
| Follow-up | 637 | ||
| References | 638 | ||
| Hyperaldosteronism | 643 | ||
| Key points | 643 | ||
| History and epidemiology | 643 | ||
| Pathophysiology and clinical impact | 644 | ||
| Diagnosis | 645 | ||
| Screening | 645 | ||
| Confirmatory Testing | 646 | ||
| Lateralization | 648 | ||
| Anatomic imaging | 648 | ||
| AVS | 649 | ||
| Additional lateralization tests | 650 | ||
| Genetic testing | 651 | ||
| Treatment | 651 | ||
| Surgical | 651 | ||
| Summary | 652 | ||
| References | 652 | ||
| Subclinical Cushing Syndrome | 657 | ||
| Key points | 657 | ||
| Introduction | 657 | ||
| Definition | 658 | ||
| Diagnosis | 658 | ||
| Rationale | 658 | ||
| Dexamethasone-Suppression Testing | 659 | ||
| Corticotropin (Adrenocorticotropic Hormone) | 660 | ||
| Dehydroepiandrosterone Sulfate | 661 | ||
| Urinary Free Cortisol | 661 | ||
| Midnight Cortisol | 661 | ||
| Approach to SCS Diagnosis in Adrenal Incidentaloma | 662 | ||
| Adrenal scintigraphy | 663 | ||
| Indications for surgery in SCS | 663 | ||
| Summary | 664 | ||
| References | 664 | ||
| Adrenocortical Cancer Update | 669 | ||
| Key points | 669 | ||
| Introduction | 669 | ||
| Clinical presentation | 670 | ||
| Imaging evaluation | 670 | ||
| Computed Tomography | 670 | ||
| Magnetic Resonance Imaging | 671 | ||
| Fluorodeoxyglucose Positron Emission Tomography | 672 | ||
| Metomidate-Based Imaging | 672 | ||
| Pathologic evaluation, prognostic factors, and staging | 672 | ||
| Pathologic Evaluation | 672 | ||
| Prognostic Factors | 673 | ||
| Surgical management of locoregional and locally advanced disease | 674 | ||
| Role of Lymphadenectomy | 675 | ||
| Role of Nephrectomy | 676 | ||
| Laparoscopic Versus Open Adrenalectomy | 676 | ||
| Surgical management of systemic and recurrent disease | 678 | ||
| Adjuvant therapy | 678 | ||
| Mitotane | 679 | ||
| Patients with low-risk to intermediate-risk ACC | 679 | ||
| Patients with locally advanced or metastatic disease | 679 | ||
| Radiotherapy | 680 | ||
| Local and Targeted Ablative Therapies | 680 | ||
| Targeted Cytotoxic Therapies | 681 | ||
| Summary | 682 | ||
| References | 682 | ||
| Nonfunctional Pancreatic Neuroendocrine Tumors | 689 | ||
| Key points | 689 | ||
| Introduction | 689 | ||
| Relevant anatomy/pathophysiology | 690 | ||
| Clinical presentation | 691 | ||
| Diagnosis | 693 | ||
| Diagnostic procedures | 694 | ||
| CT | 694 | ||
| MRI | 695 | ||
| Endoscopic Ultrasonography | 695 | ||
| Somatostatin Receptor Scintigraphy (Indium In Pentetreotide [Octreoscan]) | 695 | ||
| Surgical management | 695 | ||
| Management of hepatic metastases | 700 | ||
| Systemic therapy | 700 | ||
| Somatostatin Analogues | 700 | ||
| Cytotoxic Chemotherapy | 702 | ||
| Targeted Therapy | 702 | ||
| Everolimus | 702 | ||
| Sunitinib | 703 | ||
| Bevacizumab | 703 | ||
| Summary | 703 | ||
| References | 704 | ||
| Index | 709 |