Publications by authors named "José Vicente Tagliarini"

20 Publications

  • Page 1 of 1

Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study.

Arch Endocrinol Metab 2022 Apr 11;66(2):237-246. Epub 2022 Apr 11.

Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil,

Objective: Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution.

Methods: A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant.

Results: Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841).

Conclusion: DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.
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http://dx.doi.org/10.20945/2359-3997000000458DOI Listing
April 2022

Unsupervised type III polygraphy in children undergoing adenotonsillectomy: a technical and economic report.

Sleep Sci 2021 Jan-Mar;14(4):370-374

Botucatu Medical School - State University São Paulo, UNESP, Department of Ophthalmology and Otorhinolaryngology - Botucatu - Sao Paulo - Brazil.

Objective: To evaluate the economic and technical viability of the sleep study (type III) in children with adenotonsilar hypertrophy.

Methods: 141 children were submitted to sleep study (type III), aged between three and 11, all with symptoms of OSA. The frequency of failed examinations and a comparison of cost analysis between complete polysomnography were described.

Results: 41 exams lost at least one sensor. The sensor with the highest number of losses was the oximetry, observed in 14.28%. The 100 valid sleep studies allowed the diagnosis of severe OSA in 36 children. Sleep study accounts for approximately 63% of the value of the PSG type I, thus, it showed to be cost effective even with the repetition of the failed one.

Conclusion: Sleep study (type III) may have high failure rates and it was a reliable exam for the identification of severe OSA. The cost analysis showed economic feasibility, even with a high failure rate and necessity of repetition.
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http://dx.doi.org/10.5935/1984-0063.20200094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8776267PMC
May 2020

Thyroglobulin/thyrotropin ratio for predicting long-term response in differentiated thyroid carcinoma: a retrospective study.

Arch Endocrinol Metab 2021 Nov 16;65(4):428-435. Epub 2021 Jul 16.

Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil,

Objective: Thyrotropin-stimulated thyroglobulin (STg) after total thyroidectomy is a prognosis marker for differentiated thyroid carcinoma (DTC). As Tg level is influenced by thyrotropin (TSH), perhaps the STg/TSH ratio is also a prognosis marker for these tumours. We aimed to compare STg/TSH ratio and first STg level in differentiated thyroid carcinoma patients for their ability to predict the long-term response to initial treatment.

Methods: This retrospective study evaluated data from 181 DTC patients for first (1) STg and STg/TSH ratio, at 1-3 months post-total thyroidectomy and before iodine-131 therapy, according to response to initial therapy [Excellent/Indeterminate or Incomplete (Biochemical/Structural)] observed at final evaluation, and with the survival time with excellent/indeterminate response.

Results: Cases with incomplete response presented higher STg level [225.13 ± 585.26 ng/mL 20.4 ± 192.9 ng/mL; p < 0.001] and STg/TSH ratio (3.01 ± 7.8 0.27 ± 2.58; p < 0.001). Cutoffs of 5 ng/mL for STg and 0.085 for STg/TSH displayed sensitivities of 76.7% and 76.9%, and specificities of 79.2% and 82.6%, respectively, in predicting response to therapy. Values below these cutoffs were associated with longer survival time in excellent/indeterminate response (140.4 15.9 and 144.6 15.9 months, respectively).

Conclusion: STg/TSH ratio has a similar performance to the 1 STg in predicting long-term response to initial therapy.
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http://dx.doi.org/10.20945/2359-3997000000387DOI Listing
November 2021

Indeterminate thyroid cytology: detecting malignancy using analysis of nuclear images.

Endocr Connect 2021 Jun 29;10(7):707-714. Epub 2021 Jun 29.

Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, São Paulo, Brazil.

Background: Thyroid nodules diagnosed as 'atypia of undetermined significance/follicular lesion of undetermined significance' (AUS/FLUS) or 'follicular neoplasm/suspected follicular neoplasm' (FN/SFN), according to Bethesda's classification, represent a challenge in clinical practice. Computerized analysis of nuclear images (CANI) could be a useful tool for these cases. Our aim was to evaluate the ability of CANI to correctly classify AUS/FLUS and FN/SFN thyroid nodules for malignancy.

Methods: We studied 101 nodules cytologically classified as AUS/FLUS (n = 68) or FN/SFN (n = 33) from 97 thyroidectomy patients. Slides with cytological material were submitted for manual selection and analysis of the follicular cell nuclei for morphometric and texture parameters using ImageJ software. The histologically benign and malignant lesions were compared for such parameters which were then evaluated for the capacity to predict malignancy using the classification and regression trees gini model. The intraclass coefficient of correlation was used to evaluate method reproducibility.

Results: In AUS/FLUS nodule analysis, the benign and malignant nodules differed for entropy (P < 0.05), while the FN/SFN nodules differed for fractal analysis, coefficient of variation (CV) of roughness, and CV-entropy (P < 0.05). Considering the AUS/FLUS and FN/SFN nodules separately, it correctly classified 90.0 and 100.0% malignant nodules, with a correct global classification of 94.1 and 97%, respectively. We observed that reproducibility was substantially or nearly complete (0.61-0.93) in 10 of the 12 nuclear parameters evaluated.

Conclusion: CANI demonstrated a high capacity for correctly classifying AUS/FLUS and FN/SFN thyroid nodules for malignancy. This could be a useful method to help increase diagnostic accuracy in the indeterminate thyroid cytology.
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http://dx.doi.org/10.1530/EC-20-0648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284953PMC
June 2021

Follicular Lesions with Papillary Nuclear Characteristics: Differences in Chromatin Detected by Computerized Image Analysis.

Arch Endocrinol Metab 2021 May;64(5):630-635

Departamento de Medicina Interna, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (Unesp), Botucatu, SP, Brasil,

Objective: Follicular lesions of the thyroid with papillary carcinoma nuclear characteristics are classified as infiltrative follicular variant of papillary thyroid carcinoma-FVPTC (IFVPTC), encapsulated/well demarcated FVPTC with tumour capsular invasion (IEFVPTC), and the newly described category "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) formerly known as non-invasive encapsulated FVPTC. This study evaluated whether computerized image analysis can detect nuclear differences between these three tumour subtypes.

Methods: Slides with histological material from 15 cases of NIFTP and 33 cases of FVPTC subtypes (22 IEFVPTC, and 11 IFVPTC) were analyzed using the image processing program. Tumour cells were compared for both nuclear morphometry and chromatin textural characteristics.

Results: Nuclei from NIFTP and IFVPTC tumours differed in terms of chromatin textural features (grey intensity): mean (92.37 ± 21.01 72.99 ± 14.73, p = 0.02), median (84.93 ± 21.17 65.18 ± 17.08, p = 0.02), standard deviation (47.77 ± 9.55 39.39 ± 7.18; p = 0.02), and coefficient of variation of standard deviation (19.96 ± 4.01 24.75 ± 3.31; p = 0.003). No differences were found in relation to IEFVPTC.

Conclusion: Computerized image analysis revealed differences in nuclear texture between NIFTP and IFVPTC, but not for IEFVPTC.
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http://dx.doi.org/10.20945/2359-3997000000282DOI Listing
May 2021

Decipher me or I'll devour you: Parathyroid carcinoma, a cytomorphological challenge.

Diagn Cytopathol 2021 Apr 5;49(4):540-543. Epub 2021 Feb 5.

Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University (FMB UNESP), Botucatu, Brazil.

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http://dx.doi.org/10.1002/dc.24706DOI Listing
April 2021

Advanced Thyroid Follicular Carcinoma in a Pregnant Woman.

Case Rep Pathol 2019 28;2019:3064624. Epub 2019 Dec 28.

Pathologist, Department of Pathology, Botucatu School of Medicine, São Paulo State University (FMB UNESP) and São Luiz/D'Or Hospital, São Paulo, Brazil.

The diagnostic and therapeutic approach for pregnant women with thyroid nodules can present a challenge, especially concerning surgical procedures. In the context of malignant diagnosis, by fine needle aspiration (FNA), during pregnancy, the uncertainty lies in performing surgery. This article reports the case of a 41-year-old pregnant woman in her first gestation, who sought medical care complaining of right shoulder pain. Imaging workup depicted the destruction of the humeral head and involvement of the surrounding soft tissue. She was 20 weeks pregnant. The histological report favored the diagnosis of malignancy and the thyroid as the primary site. At 30 weeks of gestation, the patient underwent a cesarean section, a total thyroidectomy, and total resection of the metastasis. The child was born healthy, but one year after the diagnosis, the patient died. Bone and soft tissue metastasis of thyroid neoplasms are not very common and indicate poor prognosis.
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http://dx.doi.org/10.1155/2019/3064624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949678PMC
December 2019

Preoperative vitamin D level as a post-total thyroidectomy hypocalcemia predictor: a prospective study.

Braz J Otorhinolaryngol 2021 Jan-Feb;87(1):85-89. Epub 2019 Aug 6.

Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil. Electronic address:

Introduction: Hypocalcemia is one of the most common complications after total thyroidectomy. Preoperative serum vitamin D concentration has been postulated as a risk factor for this complication. However, the subject is still controversial and the role of vitamin D in the occurrence of hypocalcemia remains uncertain.

Objective: To evaluate the capability of preoperative vitamin D concentrations in predicting post-total thyroidectomy hypocalcemia.

Methods: Forty-seven total thyroidectomy patients were prospectively evaluated for serum 25(OH) vitamin D, calcium and parathyroid hormone before surgery, Calcium every 6 hours, and parathyroid hormone 8 hours post-operatively. Patients were divided according to postoperative corrected calcium into groups without (corrected calcium ≥8.5 mg/dL) and with hypocalcemia (corrected calcium <8.5 mg/dL), who were then evaluated for preoperative 25(OH) vitamin D values.

Results: A total of 72.3% of cases presented altered 25(OH) vitamin D preoperative serum concentrations and 51% evolved with postoperative hypocalcemia. The with and without hypocalcemia groups did not differ for preoperative 25(OH) vitamin D (p = 0.62). Univariate analysis showed that age (p = 0.03), postoperative PTH concentration (p = 0.02), and anatomopathological diagnosis of malignancy (p = 0.002) were predictors of postoperative hypocalcemia. In multivariate analysis only parathyroid hormone in postoperative (p = 0.02) was associated with post-total thyroidectomy hypocalcemia.

Conclusion: Preoperative serum concentrations of 25(OH) vitamin D were not predictors for post-total thyroidectomy hypocalcemia, whereas postoperative parathyroid hormone influenced the occurrence of this complication.
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http://dx.doi.org/10.1016/j.bjorl.2019.07.001DOI Listing
February 2021

Follicular thyroid lesions: is there a discriminatory potential in the computerized nuclear analysis?

Endocr Connect 2018 Aug 4;7(8):907-913. Epub 2018 Jul 4.

Internal Medicine Department, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, São Paulo, Brazil.

Background: Computerized image analysis seems to represent a promising diagnostic possibility for thyroid tumors. Our aim was to evaluate the discriminatory diagnostic efficiency of computerized image analysis of cell nuclei from histological materials of follicular tumors.

Methods: We studied paraffin-embedded materials from 42 follicular adenomas (FA), 47 follicular variants of papillary carcinomas (FVPC) and 20 follicular carcinomas (FC) by the software ImageJ. Based on the nuclear morphometry and chromatin texture, the samples were classified as FA, FC or FVPC using the Classification and Regression Trees method.

Results: We observed high diagnostic sensitivity and specificity rates (FVPC: 89.4% and 100%; FC: 95.0% and 92.1%; FA: 90.5 and 95.5%, respectively). When the tumors were compared by pairs (FC vs FA, FVPC vs FA), 100% of the cases were classified correctly.

Conclusion: The computerized image analysis of nuclear features showed to be a useful diagnostic support tool for the histological differentiation between follicular adenomas, follicular variants of papillary carcinomas and follicular carcinomas.
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http://dx.doi.org/10.1530/EC-18-0237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063880PMC
August 2018

Hypoparathyroidism: what is the best calcium carbonate supplementation intake form?

Braz J Otorhinolaryngol 2019 Jan - Feb;85(1):63-70. Epub 2017 Nov 15.

Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil. Electronic address:

Introduction: In hypoparathyroidism, calcium supplementation using calcium carbonate is necessary for the hypocalcemia control. The best calcium carbonate intake form is unknown, be it associated with feeding, juice or in fasting.

Objective: The objective was to evaluate the calcium, phosphorus and calcium×phosphorus product serum levels of hypoparathyroidism women after total thyroidectomy, following calcium carbonate intake in three different forms.

Methods: A crossover study was carried out with patients presenting definitive hypoparathyroidism, assessed in different situations (fasting, with water, orange juice, breakfast with a one-week washout). Through the review of clinical data records of tertiary hospital patients from 1994 to 2010, 12 adult women (18-50 years old) were identified and diagnosed with definitive post-thyroidectomy hypoparathyroidism. The laboratory results of calcium and phosphorus serum levels dosed before and every 30min were assessed, for 5h, after calcium carbonate intake (elementary calcium 500mg).

Results: The maximum peak average values for calcium, phosphorus and calcium×phosphorus product were 8.63mg/dL (water), 8.77mg/dL (orange juice) and 8.95mg/dL (breakfast); 4.04mg/dL (water), 4.03mg/dL (orange juice) and 4.12mg/dL (breakfast); 34.3mg/dL (water), 35.8mg/dL (orange juice) and 34.5mg/dL (breakfast), respectively, and the area under the curve 2433mg/dLmin (water), 2577mg/dLmin (orange juice) and 2506mg/dLmin (breakfast), 1203mg/dLmin (water), 1052mg/dLmin (orange juice) and 1128mg/dLmin (breakfast), respectively. There was no significant difference among the three different tests (p>0.05).

Conclusion: The calcium, phosphorus and calcium×phosphorus product serum levels evolved in a similar fashion in the three calcium carbonate intake forms.
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http://dx.doi.org/10.1016/j.bjorl.2017.10.010DOI Listing
February 2019

The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas.

Braz J Otorhinolaryngol 2019 Jan - Feb;85(1):37-42. Epub 2017 Oct 31.

Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil. Electronic address:

Introduction: Endogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce.

Objective: To assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma.

Methods: The medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence.

Results: Persistence/recurrence occurred in 27.8% of the cases. These patients were identified according to the following parameters: receiving more than one iodine dose (100% vs. 0%; p<0.0001); accumulated iodine dose (232.14±99.09 vs. 144±33.61mCi; p<0.0001); presented active disease in the last assessment (53.3% vs. 0%; p<0.0001); follow-up time (103.07±61.27 vs. 66.85±70.14 months; p=0.019); and 1st stimulated thyroglobulin (19.01±44.18 vs. 2.19±2.54ng/dL; p<0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio=1.242; 95% confidence interval: 1.022-1.509; p=0.029] and follow-up time (odds ratio=1.027; 95% confidence interval: 1.007-1.048; p=0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve=0.713 (p=0.019)].

Conclusion: The first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.
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http://dx.doi.org/10.1016/j.bjorl.2017.10.005DOI Listing
February 2019

Laryngeal and vocal alterations after thyroidectomy.

Braz J Otorhinolaryngol 2019 Jan - Feb;85(1):3-10. Epub 2017 Sep 21.

Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Disciplina de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil. Electronic address:

Introduction: Dysphonia is a common symptom after thyroidectomy.

Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy.

Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months).

Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21).

Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.
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http://dx.doi.org/10.1016/j.bjorl.2017.08.015DOI Listing
February 2019

Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary tumors: systematic review and meta-analysis of randomized and non-randomized controlled trials.

Arch Endocrinol Metab 2016 Oct 5;60(5):411-419. Epub 2016 Sep 5.

Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil.

We conducted a systematic review and meta-analysis of randomized and non-randomized controlled trials that compared pure endoscopic with microscopic transsphenoidal surgery (TSS) in the resection of pituitary tumors. Embase, PubMed, Lilacs, and Central Cochrane were used as our data sources. The outcomes were total tumor resection, achievement of biochemical control of functioning adenomas, hospital stay and surgery complications. The randomized trials were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Two randomized and three prospective controlled non-randomized studies were included. Two studies, including 68 patients, evaluated total tumor resection and the meta-analysis did not show differences between the groups [RR: 1.45 (95% CI: 0.87, 2.44)]. Three studies involving 65 patients analyzed the achievement of biochemical control and no statistical difference was found [RR: 0.94 (95% CI: 0.7, 1.26)]. All five studies compared the frequency of postoperative complications between intervention and control group and meta-analysis favored for a low rate of postoperative complications in the endoscopic TSS group [(RR: 0.37 (95% CI: 0.16, 0.83)]. Due to the low evidence level and low number of observations, the results of our meta-analysis should not be viewed as a final proof of inferiority or superiority of one approach in relation to the other. More data including higher numbers of observations are needed.
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http://dx.doi.org/10.1590/2359-3997000000204DOI Listing
October 2016

Thyroglobulin levels and thyroglobulin/thyrotropin ratio could predict the success of the ablative/therapeutic I in the differentiated thyroid cancers.

Endocr Res 2017 02 4;42(1):42-48. Epub 2016 May 4.

a Internal Medicine Department , Botucatu Medical School, São Paulo State University , Unesp, Botucatu , SP , Brazil.

Background: Stimulated thyroglobulin (STg) levels in patients with differentiated thyroid carcinomas (DTCs) after total thyroidectomy (TT) and before radioactive iodine (I) ablation/therapy (RIT) are predictive of therapeutic success but can be influenced by the thyroid-stimulating hormone (TSH) level.

Objectives: This study compared the reliability of the STg/TSH ratio and STg measurement in predicting the success of RIT.

Methods: Sixty-three DTC patients submitted to TT were assessed retrospectively to compare the ability of STg level and the STg/TSH ratio to predict successful RIT.

Results: In this study 48 (76.2%) patients had successful RIT. The successful and unsuccessful groups received different I doses and had different STg levels and STg/TSH ratios. The STg and STg/TSH ratio cutoff values that predicted successful RIT were 4.41 ng/mL (sensitivity of 86.7% and specificity of 77%) and 0.093 (sensitivity of 80% and specificity of 79.2%), respectively. Age, STg level, STg/TSH ratio, and I dose were associated with successful RIT, but after multivariate analysis only STg remained associated (p < 0.05).

Conclusion: In conclusion, our data suggest that the STg/TSH ratio and measurement of STg are equally reliable in predicting successful RIT in DTC patients.
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http://dx.doi.org/10.3109/07435800.2016.1173056DOI Listing
February 2017

Pharyngoesophageal diverticulum: evaluation of treatment results.

Rev Col Bras Cir 2013 Mar-Apr;40(2):104-9

Department of Surgery and Orthopedics, Medical School of Botucatu-Paulista State University, Botucatu, São Paulo State, Brazil.

Objective: To evaluate the postoperative outcome of patients with pharyngoesophageal diverticulum submitted to surgical and endoscopic treatments.

Methods: We retrospectively analyzed 36 patients with pharyngo-esophageal diverticulum treated at the Hospital of the Medical School of Botucatu - UNESP. Patients were divided into two groups, depending on the treatment: group 1 (n = 24): diverticulectomy associated myotomy through a left cervicotomy; group 2 (n = 12): endoscopic diverticulostomy with linear stapler.

Results: Operative mortality was zero in both groups. Early complications: group 1 - two patients developed cervical fistula and two, hoarseness; group 2 - none. Late complications: group 1 - none; group 2: recurrence of dysphagia in four patients (p = .01). Mean follow-up was 33 months for group 1 and 28 months for group 2.

Conclusion: Both procedures were effective in remission of dysphagia. Surgical treatment showed superiority to endoscopy, with resolution of dysphagia with a single procedure. Endoscopic treatment should be reserved for the elderly and those with comorbidities.
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http://dx.doi.org/10.1590/s0100-69912013000200004DOI Listing
April 2014

Factors influencing thyroidectomy complications.

Braz J Otorhinolaryngol 2012 Jun;78(3):63-9

Department of Pathology, Faculty of Medicine, Medical School of Botucatu, University of Sao Paulo, SP, Brazil.

Unlabelled: The postoperative outcome of thyroidectomies is related to factors concerning the patient, the thyroid disease, and the surgeon.

Objectives: To analyze a clinic's experience with thyroidectomy complications.

Study Design: historical cross-sectional cohort study.

Materials And Methods: We reviewed the charts from 228 patients submitted to thyroidectomy, between 1991 and 2004. Transient, permanent and total complications as well as persistence and recurrence of the basal disease were studied in relation to clinical and laboratory factors.

Results: Total complications occurred in 34.65%, transient complications in 18.86% (9.21% had hypocalcemia, 0.44% had vocal cord paralysis), associated with the first postoperative years and pressure complaints, and permanent complications in 17.98% (8.77%: hypoparathyroidism; 1.75%: vocal cord paralysis), associated with malignancy and more radical surgeries. The thyroid disease persisted in 17.98% of the cases, associated with age and recurrence in 10.96%, associated with the first operative years, benign diseases and less radical surgeries.

Conclusion: The complications were associated with pressure complaints, shorter complaining period, malignancy and more radical surgeries. The recurrence was associated with the first operative years, non-neoplastic thyroid diseases and less radical surgeries. The persistence of disease was associated with older age.
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June 2012

Does radioiodine therapy in patients with differentiated thyroid cancer increase the frequency of another malignant neoplasm?

ISRN Oncol 2011 14;2011:708343. Epub 2011 Aug 14.

Departamento de Clinica Medica, Faculdade de Medicina (FMB), UNESP, Rubiao Junior s/n, Botucatu, 18618-000 São Paulo, Brazil.

Objectives. To compare the frequency of another primary malignancy in patients with differentiated thyroid carcinoma (DTC) who received radioiodine therapy or not ((131)I). Material and Methods. 168 cases of DTC patients were retrospectively evaluated as to the frequency of another neoplasia by comparing patients with and without it, taking into account clinical, laboratory, and therapeutic parameters. Results. Another primary malignancy occurred in 8.9% of patients. Of these, 53.3% showed the malignancy before (131)I and 46.7% after it. By comparing both groups, the age at the moment of diagnosis of another neoplasia was 46.1 ± 20.2 years for the group before (131)I therapy and of 69.4 ± 11.4 years for the group after it (P = 0.02). Of the 148 patients treated with (131)I, 4.7% developed another malignancy. The latter were older (61 ± 17 years) than those who did not show another cancer type (44.1 ± 14.2 years) (P < 0.05). Conclusion. The frequency of another neoplasia found after (131)I was similar to that found before (131)I.
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http://dx.doi.org/10.5402/2011/708343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200138PMC
November 2011

Cortactin is associated with perineural invasion in the deep invasive front area of laryngeal carcinomas.

Hum Pathol 2011 Sep 21;42(9):1221-9. Epub 2011 Mar 21.

Institute of Biosciences, UNESP-São Paulo State University, Botucatu, São Paulo, Brazil.

The cortactin gene, mapped at 11q13, has been associated with an aggressive clinical course in many cancers because of its function of invasiveness. This study evaluated CTTN protein and its prognostic value in the deep invasive front and superficial areas of laryngeal squamous cell carcinomas. The transcript expression levels were evaluated in a subset of cases. Overexpression of CTTN cytoplasmatic protein (80% of cases in both the deep invasive front and superficial areas) and transcript (30% of samples) was detected in a significant number of cases. In more than 20% of cases, observation verified membrane immunostaining in the deep invasive front and superficial areas. Perineural invasion was significantly associated with N stage and recurrence (P = .0058 and P = .0037, respectively). Higher protein expression levels were correlated with perineural invasion (P = .004) in deep invasive front cells, suggesting that this area should be considered a prognostic tool in laryngeal carcinomas. Although most cases had moderate to strong CTTN expression on the tumor surface, 2 sets of cases revealed a differential expression pattern in the deep invasive front. A group of cases with absent to weak expression of CTTN in the deep invasive front showed good prognosis parameters, and a second group with moderate to strong expression of CTTN were associated with an unfavorable prognosis, suggesting an association with worse outcome. Taken together, these results suggest that the deep invasive front might be considered a grading system in laryngeal carcinomas and that cortactin is a putative marker of worse outcome in the deep invasive front of laryngeal carcinomas.
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http://dx.doi.org/10.1016/j.humpath.2010.05.030DOI Listing
September 2011

[Ethmoid sinus osteoma with orbital invasion: report of three cases and review of the literature].

Arq Bras Oftalmol 2007 Nov-Dec;70(6):1024-8

Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, Brasil.

We report three rare cases of ethmoid osteoma extending to the medial quadrant of the orbit that had singular particularities, such as occurring in women, at an unusual age group, and complaint of epiphora. The radiographic images were typical of this condition. Patients were submitted to surgery with complete resolution of the disease.
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http://dx.doi.org/10.1590/s0004-27492007000600027DOI Listing
August 2008

Human papillomavirus and Epstein-Barr virus infection, p53 expression, and cellular proliferation in laryngeal carcinoma.

Am J Clin Pathol 2006 Aug;126(2):284-93

Department of Pathology, Botucatu School of Medicine at Sao Paulo State University, Sao Paulo, Brazil.

Laryngeal carcinomas are aggressive neoplasms with controversial association with the human papillomavirus (HPV) and Epstein-Barr virus (EBV). So far, the impairment of p53 protein function and its impact on cellular proliferation has not been studied adequately in these tumors. In this work, molecular biologic techniques were used to assess the frequency of HPV and EBV in 110 squamous cell carcinomas of the larynx. In addition, accumulation of p53 and Ki-67 cell proliferation antigen expression in malignant cells was assessed by immunohistochemical analysis. High-grade HPV was found in 37.3% of cases, and none had demonstrable EBV infection. Accumulation of p53 was found in 78.2% of the cases, and it was related to a high Ki-67 labeling index and higher histologic grade. The results demonstrate association of HPV with more than one third of laryngeal carcinomas studied, mainly glottic tumors. Tumors with increased cell proliferation were more frequently high grade, with p53 accumulation and lymph node metastasis.
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http://dx.doi.org/10.1309/UU2J-ADUE-HDWA-TVM9DOI Listing
August 2006
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