Adverse Histological Features of Differentiated Thyroid Cancer Are Commonly Found in Autopsy Studies: Implications for Treatment Guidelines.

Background: While the popularity of lobectomy for differentiated thyroid cancer (DTC) has increased since the 2015 ATA (American Thyroid Association) guidelines, recent studies reported that adverse histological features (minimal extrathyroidal extension [mETE], multifocality, vascular invasion, and lymph node [LN] metastases) may be found in 30-60% of lobectomy specimens, questioning the validity of this approach. Aim: To assess the prevalence adverse histological features in occult DTC detected in autopsy studies. Methods: Meta-analysis of autopsy studies of the thyroid in subjects without known history of thyroid cancer. Results: Twenty-nine studies including 8750 subjects fulfilled the inclusion criteria, with incidentally discovered DTC in 740 autopsies (8.5%). Age was reported in 17 studies, with a median age of 61 years (range 41-68 years). Multifocality was reported in 27 studies with a calculated event rate of 28.2% ([CI 23.1-33.8], I2 = 46.3%), with bilateral involvement in 18% [CI 12.6-25.1]. mETE was reported in 5 studies, with an event rate of 24.5% ([CI 9.3-50.7], I2 = 88.5%), and the presence of LN metastases were reported in 13 studies with an event rate of 11% ([CI 6.1-19.1], I2 = 69.5%). Vascular invasion was reported in seven studies with an event rate of 16% ([CI 4-47], I2 = 86.8%). Of 25 studies with whole body autopsies (722 subjects), 3 cases of distant metastases were reported, of which 2 had fatal metastatic disease (where thyroid origin was not diagnosed before death), and 1 had occult disease. Conclusions: Adverse histological features including mETE, LN metastases, multifocality, and vascular invasion are common in occult DTC. When minimal in size, these adverse histological features do not seem to be markers of aggressive disease and may not be an indication for completion thyroidectomy or radioiodine therapy.

An International Multicenter Comparison of IBD-Related Disability and Validation of the IBDDI.

BACKGROUND: The IBD disability index (IBDDI) has been shown to be valid and reliable. We compared the distributional and predictive properties of the IBDDI, when collected from five populations of people living with IBD- from Winnipeg, Chicago, Toronto, Hong Kong, and Jerusalem. METHODS: People with IBD from five jurisdictions were invited to complete a survey including the IBDDI, the World Health Organization Disability Assessment Scale, the Work and Social Adjustment Scale, the IBDQ, the Kessler-6 distress scale, and the Stanford presenteeism scale. Between sites, we compared the correlation between IBDDI and the other 4 measures of disability/quality of life/distress, and the association between IBDDI and presenteeism and having been hospitalized in the past year. RESULTS: There were 1121 participants from Winnipeg, 511 from Chicago, 147 from Toronto, 97 from Hong Kong, and 96 from Jerusalem. The majority had Crohn's disease. Although the mean IBDDI score varied by site, the correlation between IBDDI and each of the other 4 measures of disability/QOL/distress was nearly identical. Similarly, the regression coefficient showing the association between IBDDI and presenteeism was nearly identical in all sites, and the risk ratios showing the association between hospitalization and high IBDDI was similar in all sites. CONCLUSION: The correlation between IBDDI and different measures of disability/QOL/distress was similar across all sites. There is strong evidence of the association between IBD-related disability and presenteeism, and between hospitalization and high IBD-related disability, and that the associations are the same across different populations. The severity of disability that an individual with a given IBDDI score has is directly comparable across populations.

[DISABILITY AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A CROSS SECTIONAL STUDY].

INTRODUCTION: nflammatory bowel diseases (IBD) which include Crohn's disease and ulcerative colitis cause chronic remitting inflammation of the gastrointestinal tract with the potential of bowel wall injury which can lead to disability. AIMS: This study aimed to evaluate the degree of disability among IBD patients in Israel using validated scales and to identify factors that are associated with disability. Furthermore, the study aimed to examine the association between disability and quality of life (QoL) among patients. METHODS: The study population included 96 patients who attended a dedicated IBD clinic, (71 patients (pts) with Crohn's disease (CD), 22 pts with ulcerative colitis (UC) and 3 pts with IBD-undefined (IBD-U)). The participants completed a 5-part questionnaire which included demographic parameters, a validated QoL measure (inflammatory bowel disease questionnaire (IBDQ), two validated disability scales (the work and social adjustment scale (WSAS) and the World Health Organization Disability Assessment Schedule V.2.0 (WHODAS2.0), employment status, and a disease activity measure (the Manitoba IBD index (MIBDI). RESULTS: Major disability was found among 20% of the participants (as defined by a WSAS score ≥17). Major disability was significantly associated with lower QoL (p<0.001) and with recognition of disability from the National Insurance Institute of Israel ("Hamosad Lebituach Leumi") (p=0.005). Significant association was found between WHODAS2.0 and low QoL (r=-0.763,p<0.001). There were no significant differences in rates of major disability among patients with CD vs. those with UC. CONCLUSIONS: Approximately one fifth of IBD patients in Israel have major disability, which in turn, is associated with a decreased quality of life and recognition of disability from the National Insurance Institute of Israel. There were no significant differences in rates of disability between patients with CD vs. those with UC.