151
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Divarci E, Ulman H, Ozok G, Ozen S, Ozdemir M, Makay O. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): A novel surgical technique for scarless thyroidectomy in pediatric surgery. J Pediatr Surg 2022; 57:1149-1157. [PMID: 35232598 DOI: 10.1016/j.jpedsurg.2022.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel surgical technique in thyroid surgery that provides a feasible opportunity to avoid a visible neck scar. In recent years, TOETVA became popular in the thyroid surgery of selected adult patients with cosmetic concerns. We conducted a right lobectomy with the TOETVA technique in a 17-year-old adolescent with a suspicious thyroid nodule the present report aimed to describe the details of the operative technique step by step. Level of evidence: LEVEL IV, case series with no comparison group.
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Affiliation(s)
- Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Hilmican Ulman
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey; Department of Pediatrics, Division of Pediatric Endocrinology, Ege University Faculty of Medicine, Izmir, Turkey; Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Samim Ozen
- Department of Pediatrics, Division of Pediatric Endocrinology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Murat Ozdemir
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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152
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Trimboli P, Camponovo C, Ruinelli L. The dilemma of routine testing for calcitonin thyroid nodule's patients to detect or exclude medullary carcinoma: one single negative test should be valuable as rule-out strategy to avoid further calcitonin measurements over time. Endocrine 2022; 77:80-85. [PMID: 35391593 PMCID: PMC9242962 DOI: 10.1007/s12020-022-03047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/22/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE While calcitonin (CT) measurement is recognized as the most accurate tool to diagnose medullary thyroid carcinoma (MTC), its routine use in patients with thyroid nodule (TN) is not universally accepted. The present study raised the question whether a TN patient with an initial normal CT can have suspicious CT levels (i.e., at least >20 pg/ml) later during his follow-up. METHODS The historical database of our institution was searched to select TN patients undergone multiple CT tests, having an initial normal CT, and clinically followed up for years. The event of a CT above 20 pg/ml (mild-to-moderate suspicion) and 100 pg/ml (high suspicion) was searched in the follow-up of the included patients. RESULTS According to the study design, the study sample encompassed 170 patients (131 female, 39 male) with initial CT value ≤10 pg/ml. On the first CT test, patients were 54.8 years and median CT was 2.1 pg/ml in both females and males. Over a period of 14.5 years and a median clinical follow-up of patients of 53.0 (23.9-102.5) months, MTC could be excluded by histology or cytology in 109 (64%) and clinically in the remaining ones. On the follow-up over time, no patients had CT >20 pg/ml and only two cases had CT just above 10 pg/ml. CONCLUSION According to the present results, one single CT testing with normal value could be reasonably used as a rule-out strategy in patients with TN to avoid further CT measurements.
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Affiliation(s)
- Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland.
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), 6900, Lugano, Switzerland.
| | - Chiara Camponovo
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
| | - Lorenzo Ruinelli
- Team Data Science & Research, Area ICT, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
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153
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Baldwin CK, Natter MB, Patel KN, Hodak SP. Minimally Invasive Techniques for the Management of Thyroid Nodules. Endocrinol Metab Clin North Am 2022; 51:323-349. [PMID: 35662444 DOI: 10.1016/j.ecl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Image-guided interventional techniques have emerged as promising treatments for thyroid disease. Percutaneous ethanol ablation, radiofrequency ablation, laser ablation, high intensity focused ultrasound, and microwave ablation have shown efficacy in treating benign thyroid disease. There is increasing evidence that these techniques may effectively treat papillary thyroid microcarcinomas, recurrent and metastatic disease, follicular neoplasms, and parathyroid lesions. They are performed in an outpatient setting, well-tolerated, with negligible risk for thyroid hormone supplementation, making them a popular alternative to surgical resection. In this comprehensive review, we discuss the devices, techniques, advantages, and disadvantages of each intervention, and summarize the published outcomes.
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Affiliation(s)
- Chelsey K Baldwin
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA.
| | - Michael B Natter
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
| | - Kepal N Patel
- Otolaryngology and Biochemistry, Division of Endocrine Surgery, Department of Surgery, Division of Endocrine Surgery, New York University School of Medicine, 530 1st Avenue, Floor 12, NY 10016, USA
| | - Steven P Hodak
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
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Hurtado-Lopez LM, Carrillo-Muñoz A, Zaldivar-Ramirez FR, Basurto-Kuba EOP, Monroy-Lozano BE. Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system. World J Methodol 2022; 12:148-163. [PMID: 35721246 PMCID: PMC9157633 DOI: 10.5662/wjm.v12.i3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/27/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study evaluates the American Thyroid Association (ATA) ultrasound (US) classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making.
AIM To perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules.
METHODS In accordance with the PRISMA statement for diagnostic test accuracy, we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard. We analyzed these cases using traditional diagnostic parameters, as well as the threshold approach to clinical decision-making and decision curve analysis.
RESULTS We reviewed 13 articles with 8445 thyroid nodules, which were classified according to 2015 ATA patterns. Of these, 46.62% were malignant. No cancer was found in any of the ATA benign pattern nodules. The Bayesian analysis post-test probability for cancer in each classification was: (1) Very-low suspicion, 0.85%; (2) Low, 2.6%; (3) Intermediate, 6.7%; and (4) High, 40.9%. The net benefit (NB), expressed as avoided interventions, indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy (FNAB) in the patterns that we studied was 42, 31, 35, and 43 of every 100 FNABs. The NB calculation for a probability threshold of 11% for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules.
CONCLUSION These three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful, in which case, FNAB should be performed. However, the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules. Therefore, it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules, as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.
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Affiliation(s)
| | - Alfredo Carrillo-Muñoz
- Thyroid Clinic, General Surgery Service, Hospital General de Mexico, Mexico 06726, Mexico
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155
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Fawcett C, Eppenberger-Castori S, Zechmann S, Hanke J, Herzog M, Savic Prince S, Christ ER, Ebrahimi F. Effects of Rapid On-Site Evaluation on Diagnostic Accuracy of Thyroid Fine-Needle Aspiration. Acta Cytol 2022; 66:371-378. [PMID: 35512664 PMCID: PMC9501752 DOI: 10.1159/000522662] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is well-established for the evaluation of suspicious thyroid nodules. However, a significant proportion is nondiagnostic. Rapid on-site evaluation (ROSE) has been proposed to improve the overall adequacy of FNA. METHODS Retrospective cohort study comparing adequacy of thyroid FNA findings pre- and postimplementation of ROSE at a tertiary center in Switzerland. Patients undergoing thyroid FNA from January 2016 to December 2019 were included. The primary outcome was the rate of nondiagnostic findings (Bethesda System for Reporting Thyroid Cytopathology category I). RESULTS In total, 410 thyroid nodule FNAs were performed. Of those, 309 with standard FNA and 101 with ROSE. The majority of patients were female (71%), with a median age of 56 years (IQR 46-68) and a nodule diameter of 1.9 cm (IQR 1.2-2.9). Implementation of ROSE led to a decrease in nondiagnostic findings from 41.1% to 23.8%, with an odds ratio of 0.42 (95% CI: 0.24-0.72; p = 0.002). Implementation of ROSE was associated with significantly higher rates of Bethesda category III (27.7% vs. 19.1%), category IV (15.8% vs. 5.5%), and Bethesda category VI (6.9% vs. 2.3%). Repeated FNA was performed in 29.1% before and 20.8% after implementation of ROSE (p = 0.18). The mean number of FNA per nodule was reduced from 1.4 (0.6) to 1.2 (0.4) with ROSE (p = 0.04). CONCLUSIONS Implementation of ROSE of thyroid nodule specimen improved diagnostic adequacy of FNA, reducing nondiagnostic findings. However, due to increased equivocal findings (Bethesda category III), there was no significant reduction of repeat FNA.
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Affiliation(s)
- Celia Fawcett
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | | | - Stefan Zechmann
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Jasmin Hanke
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Michelle Herzog
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Spasenija Savic Prince
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Emanuel Remigius Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Clarunis, University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
- *Fahim Ebrahimi,
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Huang L, Yang S, Bai M, Lin Y, Chen X, Li G, Cui LG, Wang X. Thermal shielding performance of self-healing hydrogel in tumor thermal ablation. Colloids Surf B Biointerfaces 2022; 213:112382. [PMID: 35151993 DOI: 10.1016/j.colsurfb.2022.112382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
Thermal ablation therapy is widely used in the surgical treatment of tumors. Clinically, normal saline is generally used as an insulator to protect adjacent tissues from local high-temperature burns caused by thermal ablation. However, the flow of saline causes fluid loss, requiring frequent injections and complex operation, which is easy to lead to complications such as secondary injury and hematoma. Here, a self-healing chitosan-PEG (CP) hydrogel was proposed as a protective medium to challenge the clinical preparations. Compared with saline and non-self-healing hydrogel F127, CP hydrogel exhibited outstanding thermal shielding performance in the thermal ablation of thyroid nodule in a Beagle dog model. The transient plane source (TPS) method is used to measure thermal properties, including thermal conductivity, thermal diffusivity and specific heat capacity. The thermal shielding mechanism and clinical advantages including operability, biodegradability, and biological safety of self-healing hydrogel are then revealed in-depth. Therefore, self-healing hydrogel can achieve much better thermal management in tumor thermal ablation.
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Affiliation(s)
- Lifei Huang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Shiyuan Yang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Mingyu Bai
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Yuxuan Lin
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Xue Chen
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Guofeng Li
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China.
| | - Xing Wang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China.
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157
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Cortázar-García R, Martín-Escalante MD, Robles-Cabeza L, Martínez-Santos C. Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings. Radiologia (Engl Ed) 2022; 64:195-205. [PMID: 35676051 DOI: 10.1016/j.rxeng.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. MATERIAL AND METHODS This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. RESULTS Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. CONCLUSIONS Core-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.
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158
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Li F, Huang F, Liu C, Pan D, Tang X, Wen Y, Chen Z, Qin Y, Chen J. Parameters of dual-energy CT for the differential diagnosis of thyroid nodules and the indirect prediction of lymph node metastasis in thyroid carcinoma: a retrospective diagnostic study. Gland Surg 2022; 11:913-926. [PMID: 35694089 PMCID: PMC9177276 DOI: 10.21037/gs-22-262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/18/2022] [Indexed: 08/29/2023]
Abstract
BACKGROUND To further investigate the differential diagnosis of thyroid nodules using dual-energy computed tomography (DECT) and explore the relationship between DECT parameters and lymph node metastasis in thyroid carcinoma for clinical practice, especially difficult diagnosis by routine imaging examination. METHODS A total of 150 patients with thyroid nodules who underwent preoperative DECT and Thyroid Imaging Report and Data System (TIRADS) classification were enrolled in this study, including 96 patients with malignant tumors and 54 with benign tumors. The DECT parameters were got form regions of interest (ROI) by an experienced radiologist team and thyroid nodules and lymph node status of all patients were identified by cytology and histopathology. Statistical analyses were performed using Student's t-test, Chi-squared test, and receiver operating characteristic (ROC) curves. RESULTS In the differential diagnosis of benign and malignant thyroid nodules, the optimal iodine concentration (IC) and normalized iodine concentration (NIC) cut-off values were ICa (2.835 mg/mL), NIC1a (0.690), and their corresponding area under the curve (AUC) were 0.940, 0.954 respectively; meantime, the optimal computed tomography (CT) value and slope of the spectral Hounsfield unit curve (λHU) cut-off values were 70 keVa (125.05 HU) and λHU2a (1.405), and their corresponding AUC were 0.955, 0.941 respectively. For lymph node status (with or without lymph node metastasis), the optimal IC and NIC thresholds were ICa (1.715 mg/mL) and NIC2a (0.155), and their corresponding AUC were 0.717, 0.720 respectively; meanwhile, the optimal CT value and λHU thresholds were 70 keVv (89.635 HU) and λHU2v (1.185), and their corresponding AUC were 0.729, 0.641 respectively. CONCLUSIONS Base on our study, we think DECT is useful in differentiating malignant from benign thyroid nodules, which has potential value in the indirect prediction of lymph node metastasis in thyroid carcinoma.
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Affiliation(s)
- Fu Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fuling Huang
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chenmin Liu
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Denghua Pan
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoqi Tang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Wen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhibai Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuhong Qin
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
- The Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, Nanning, China
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Lee E, Terhaar S, McDaniel L, Gorelik D, Gerhard E, Chen C, Ma Y, Joshi AS, Goodman JF, Thakkar PG. Diagnostic performance of the second-generation molecular tests in the assessment of indeterminate thyroid nodules: A systematic review and meta-analysis. Am J Otolaryngol 2022; 43:103394. [PMID: 35241290 DOI: 10.1016/j.amjoto.2022.103394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to evaluate the diagnostic performance of the second-generation molecular tests in the diagnosis of thyroid nodules with indeterminate fine-needle aspiration biopsy results. METHODS We searched PubMed, Google Scholar, Scopus, and Cochrane Library for studies published between January 2017 and March 2021. Inclusion criteria were indeterminate thyroid results from fine-needle aspiration (FNA) that included Bethesda categories III and IV, use of Afirma GSC, Thyroseq v3, and ThyGeNext as an index test, and conclusive histopathological results. Studies with no post-surgical diagnoses were excluded. For each included study, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were obtained. Sensitivity and specificity were pooled jointly using a bivariate binomial random-effects model. Statistical significance was indicated at p-value less than 0.05. RESULTS Our search yielded 431 non-duplicate articles, of which 15 were included in the study (7 GSC, 6 Thyroseq v3, and 2 ThyGeNext). ThyGeNext studies were excluded from the meta-analysis due to the small sample size. Pooled data for GSC studies on 472 thyroid nodules showed a sensitivity of 96.6 (95% confidence interval: 89.7-98.9%), specificity of 52.9% (23.4-80.5%), PPV of 63% (51-74%), and NPV of 96% (94-98%). Pooled data for ThyroSeq studies on 530 thyroid nodules showed a sensitivity of 95.1% (91.1-97.4%), specificity of 49.6% (29.3-70.1%), PPV of 70% (55-83%), and NPV of 92% (86-97%). There was no statistically significant difference in diagnostic performances of the two tests (p-values for sensitivity = 0.89, specificity = 0.82, PPV = 0.43, NPV = 0.17). CONCLUSION High sensitivity and high NPV in GSC and Thyroseq v3 have potential to help rule out malignancy among thyroid nodules with indeterminate cytology results. There was no difference in diagnostic performances between the two molecular tests indicating that either test is appropriate to determine the malignancy of thyroid nodules. Further long-term outcome data are warranted to make a clear recommendation.
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160
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Park JY, Yi SY, Baek SH, Lee YH, Kwon HJ, Park HJ. Diagnostic efficacy, performance and safety of side-cut core needle biopsy for thyroid nodules: comparison of automated and semi-automated biopsy needles. Endocrine 2022; 76:341-348. [PMID: 35032314 DOI: 10.1007/s12020-022-02980-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/09/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE This study was performed to compare the utility of the semi-automated and automated side-cut core biopsy needles for thyroid nodules. METHODS Between January 2014 and March 2020, biopsy was performed for 278 thyroid nodules using the semi-automated core needle and for 225 nodules using the automated core needle. Nondiagnostic rate, inconclusive rate, diagnostic performance and complication rates were evaluated and compared between two core needle types. RESULTS There were 1.2% (6/503) nondiagnostic results and 15.9% (80/503) inconclusive results. Nondiagnostic rate between two needle types was not significantly different. The semi-automated type (33/278, 11.9%) showed lower inconclusive rate than the automated type (47/225, 20.9%) (p = 0.006). The sensitivity, specificity, PPV, NPV and diagnostic accuracy for diagnosis of malignancy of the semi-automated type were 70.18, 100, 100, 84.96 and 88.89%, respectively; the corresponding rates of automated type were 70.45, 100, 100, 86.6, and 89.84%. There were 12 minor complications: four hematomas (4/278, 1.4%) for the semi-automated type and eight hematomas (8/225, 3.6%) for the automated type, which difference was not statistically significant. CONCLUSION Core needle biopsy for thyroid nodules using either the semi-automated or automated needle is a safe diagnostic tool. Semi-automated needle has lower inconclusive rate than automated needle.
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Affiliation(s)
- Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
| | - Soo Heui Baek
- Department of Radiology, Daerim St. Mary's Hospital, Seoul, Republic of Korea
| | - Yu Hyun Lee
- Department of Radiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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161
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Pollack R, Koch N, Mazeh H, Cahn A, Katz L, Appelbaum L. Consistency of TI-RADS Reporting in Community-Based Imaging Centers vs. a Large Tertiary Hospital. Endocr Pract 2022; 28:754-759. [PMID: 35452816 DOI: 10.1016/j.eprac.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In our country, thyroid nodules are sonographically evaluated in health maintenance organization (HMO) imaging centers, and patients are referred to tertiary hospitals for ultrasound-guided fine needle aspiration (FNA) biopsy when indicated. We evaluated the concordance in Thyroid Imaging Reporting and Data System (TI-RADS) classification reporting between these sites. METHODS We conducted a retrospective cohort study reviewing the sonographic features of thyroid nodules evaluated both at the HMO and a large tertiary center between January 2018 and December 2019. The primary outcome was concordance between the TI-RADS classification at both sites. Additional endpoints included correlation of TI-RADS to the Bethesda category following FNA and correlation of TI-RADS with malignancy on final pathology at each site. RESULTS The records of 336 patients with 370 nodules were reviewed. The level of concordance was poor (19.8%), with 277 (74.8%) nodules demonstrating higher TI-RADS and 20 (5.4%) lower TI-RADS at the HMO compared to the hospital (p<0.001, weighted Kappa = 0.120). FNA results were available for 236 (63.8%) nodules. The Bethesda category strongly correlated with the hospital TI-RADS (p<0.001), yet not with HMO TI-RADS (p=0.123). In the 57 nodules surgically removed, a strong correlation was identified between malignancy on final pathology and TI-RADS documented at the hospital (p<0.001), yet not at the HMO (p=0.259). CONCLUSIONS There is poor agreement between TI-RADS classification on ultrasound performed in the HMO compared to a tertiary hospital. The hospital TI-RADS strongly correlated with Bethesda category and final risk of malignancy unlike the HMO.
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Affiliation(s)
- Rena Pollack
- Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel; The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Noam Koch
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haggi Mazeh
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Avivit Cahn
- Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel; The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Liat Appelbaum
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
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162
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Zia-Ul-Hussnain HM, Kgosidialwa O, Kennedy C, Quinn M, Dolan E, Deignan P, Sherlock M, Thompson CJ, Smith D, O'Neill JP, Hill A, Leader M, Barrett H, Ryan C, Keeling F, Morrin MM, Agha A. Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series. BMC Endocr Disord 2022; 22:102. [PMID: 35428234 PMCID: PMC9013082 DOI: 10.1186/s12902-022-01014-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND : Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2). METHODS We retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria. RESULTS The mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%). CONCLUSIONS With a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.
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Affiliation(s)
| | | | - Carmel Kennedy
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Mark Quinn
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Emma Dolan
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Paul Deignan
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Chris J Thompson
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | | | - Arnold Hill
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Mary Leader
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Helen Barrett
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Cliona Ryan
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Frank Keeling
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Amar Agha
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland.
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163
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Mauri G, Bernardi S, Palermo A, Cesareo R. Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians by the Italian Minimally-Invasive Treatments of the Thyroid group. Endocrine 2022; 76:1-8. [PMID: 35290617 PMCID: PMC8986658 DOI: 10.1007/s12020-022-03005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE In this paper, the members of the Italian Working Group on Minimally-Invasive Treatments of the Thyroid (MITT group) aim to summarize the most relevant information that could be of help to referring physicians and that should be provided to patients when considering the use of MITT for the treatment of benign thyroid nodules. METHODS An interdisciplinary board of physicians with specific expertise in the management of thyroid nodules was appointed by the Italian MITT Group. A systematic literature search was performed, and an evidence-based approach was used, including also the knowledge and the practical experience of the panelists to develop the paper. RESULTS The paper provides a list of questions that are frequently asked by patients to operators performing MITT, each with a brief and detailed answer and more relevant literature references to be consulted. CONCLUSIONS This paper summarizes the most relevant information to be provided to patients and general practitioners/referring physicians about the use of MITT for the treatment of benign thyroid nodules.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy.
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.
| | - Stella Bernardi
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
- UCO Medicina Clinica, Azienda Sanitaria Universitaria Integrata Trieste (ASUGI), Trieste, Italy
| | - Andrea Palermo
- Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Ospedale Santa Maria Goretti, Latina, Italy
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164
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Jia MR, Baran JA, Bauer AJ, Isaza A, Surrey LF, Bhatti T, McGrath C, Jalaly J, Mostoufi-Moab S, Adzick NS, Kazahaya K, Sisko L, Franco AT, Escobar FA, Krishnamurthy G, Patel T, Baloch Z. Utility of Fine-Needle Aspirations to Diagnose Pediatric Thyroid Nodules. Horm Res Paediatr 2022; 94:263-274. [PMID: 34469888 DOI: 10.1159/000519307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Risk of malignancy for pediatric thyroid nodules classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is not well defined. Correlations between risk of malignancy and ancillary clinical data remain inconclusive. We report a single institutional experience of fine-needle aspiration (FNA) to improve upon current management paradigm of thyroid nodules. METHODS A retrospective chart review of 575 thyroid nodules was performed of 324 patients who underwent 340 FNAs between 2008 and 2018 at the Children's Hospital of Philadelphia. Demographics, ultrasound (US) characteristics, FNA cytology, surgical pathology, and ancillary data were reviewed. RESULTS The rate of malignancy according to TBSRTC was 0.0% for category I, 0.8% for category II, 15.6% for category III, 54.5% for category IV, 100.0% for category V, and 100.0% for category VI. The cumulative Thyroid Imaging Reporting and Data System (TI-RADS) score was significantly correlated with benign and malignant nodules on pathology (p < 2.2e-16). Distribution of TI-RADS for cytologically indeterminate nodules with benign or malignant pathology revealed significant differences for composition (p = 3.20e-8) and echogenic foci (p = 0.005) but not for echogenicity (p = 0.445), shape (p = 0.160), margins (p = 0.220), and size (p = 0.105). Distributions of thyroid-stimulating hormone levels between benign and malignant patients was significant (p = 1.58e-3). CONCLUSIONS Nodules with TI-RADS scores >3 should undergo FNA, irrespective of size; surgical resection is recommended for nodules classified as TBSRTC category IV and V due to high risk of malignancy. US surveillance instead of FNA can be performed for nodules with TI-RADS scores ≤3.
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Affiliation(s)
- Margaret R Jia
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Julia A Baran
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,
| | - Amber Isaza
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lea F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tricia Bhatti
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cindy McGrath
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jalal Jalaly
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ken Kazahaya
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lindsay Sisko
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aime T Franco
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Fernando A Escobar
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ganesh Krishnamurthy
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tasleema Patel
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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165
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Karabacak U, Derebey M, Tarim I, Polat AK. FACTORS AFFECTING MALIGNANCY IN THYROID NODULES WITH NON-DIAGNOSTIC FINE NEEDLE ASPIRATION BIOPSY RESULT. Acta Endocrinol (Buchar) 2022; 18:187-193. [PMID: 36212253 PMCID: PMC9512379 DOI: 10.4183/aeb.2022.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Non-diagnostic (ND) fine needle aspiration biopsy (FNAB) results are problematic for clinicians who want to accurately diagnose malignancy and avoid unnecessary thyroidectomies. In this study, we aimed to investigate the incidence of malignancy in nodules whose first FNAB result was ND, and ultrasonography (USG) findings affecting malignancy and the effectiveness of repetitive biopsies. PATIENTS AND METHOD In our clinic, 156 consecutive nodules whose first FNAB were ND according to the Bethesda system and underwent thyroidectomy between 1 January 2011 and 1 January 2018, directly or after repeated biopsies, were retrospectively analyzed. RESULTS Malignancy was detected in 44 (28%) of 156 nodules that were ND in the first FNAB. Twenty-two (31%) of 72 nodules that underwent FNAB for the second time resulted in ND again. The malignancy rate of nodules with two consecutive ND results was 23%. Of the USG features, a significant correlation was found between malignancy and solid nodule structure (p<0.001), microcalcification (p=0.025), cervical lymphadenopathy (LAP) (p=0.004) and medium-high risk USG pattern (p=0.002). In multivariate analysis, only the solid nodule structure (p<0.002) and the presence of cervical LAP (p=0.013) resulted as independent predictive factors. CONCLUSION Diagnostic thyroidectomy is an effective method for reaching the diagnosis in selected patients considering the USG findings.
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Affiliation(s)
- U. Karabacak
- Cumhuriyet University, Faculty of Medicine - Surgical Oncology, Sivas, Turkey
| | - M. Derebey
- Ondokuz Mayis University, Faculty of Medicine - General Surgery, Samsun Turkey
| | - I.A. Tarim
- Ondokuz Mayis University, Faculty of Medicine - General Surgery, Samsun Turkey
| | - A. Kamali Polat
- Ondokuz Mayis University, Faculty of Medicine - General Surgery, Samsun Turkey
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166
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Xu N, Liu H, Wang Y, Xue Y. Relationship between insulin resistance and thyroid cancer in Chinese euthyroid subjects without conditions affecting insulin resistance. BMC Endocr Disord 2022; 22:58. [PMID: 35255873 PMCID: PMC8903656 DOI: 10.1186/s12902-022-00943-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUNDS In recent years, many studies have shown that insulin resistance is related to the occurrence of thyroid cancer, but there are few reports on whether the two are related under the premise that thyroid function is normal and the metabolic components related to insulin resistance are excluded. This study aims to analyze the insulin resistance of patients with differentiated thyroid cancer after excluding the population with abnormal metabolic components, and to study the risk factors of thyroid cancer in this population. METHODS 61 subjects diagnosed with differentiated thyroid carcinoma (DTC) formed the DTC group and 262 subjects with benign nodules formed the control group. Body mass index (BMI, kg/m2), waist circumference (WC), lipid profiles, and free T3 (FT3), free T4 (FT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TGAb), alanine transaminase (ALT), aspartate aminotransferase (AST), fasting plasma glucose (FPG), fasting serum insulin and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured. RESULTS Mean subjects age (P = 0.021), BMI (P = 0.049), WC (P = 0.01), serum insulin concentration (P = 0.006), and HOMA-IR level (P = 0.005) were significantly greater in the DTC group than in the control group. Multivariate binary logistic regression analysis identified advanced age (OR = 1.027 [1.003-1.051], P = 0.029) and an increased HOMA-IR level (OR = 1.572 [1.277-1.935], P < 0.001) as significant risk factors for thyroid cancer. CONCLUSIONS IR may increase the risk of thyroid cancer development even in the absence of conditions affecting insulin resistance.
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Affiliation(s)
- Ning Xu
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, 116027, P.R. China
| | - Haixia Liu
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, 116027, P.R. China.
| | - Yuan Wang
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, 116027, P.R. China
| | - Yimiao Xue
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, 116027, P.R. China
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167
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Semsar-Kazerooni K, Morand GB, Payne AE, da Silva SD, Forest VI, Hier MP, Pusztaszeri MP, Tamilia M, Payne RJ. Mutational status may supersede tumor size in predicting the presence of aggressive pathologic features in well differentiated thyroid cancer. J Otolaryngol Head Neck Surg 2022; 51:9. [PMID: 35246262 PMCID: PMC8895819 DOI: 10.1186/s40463-022-00559-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background In clinical practice, thyroid tumor size plays a critical role in the staging of thyroid malignancies and in the selection of nodules that should undergo ultrasound-guided fine-needle aspiration. Thyroid tumor size is influenced by the elapsed time since the beginning of oncogenesis and by the presence of somatic mutations driving growth, such as BRAFV600E mutations, associated with aggressive phenotypes, and RAS-like mutations, associated with more indolent behavior. Although large nodules are often considered to be more alarming, the true impact of tumor size on prognosis remains controversial. The aim of this study was to assess the relationship between mutational status, tumor size and aggressiveness, with emphasis on BRAFV600E and RAS-like mutations. Method We conducted a multicentric retrospective chart review in Montréal, Canada, of all patients who underwent thyroid surgery between January 2016 and December 2020, with well-differentiated thyroid cancer on final pathology, and who had undergone molecular testing revealing the presence of BRAFV600E mutations or RAS-like mutations (NRAS, HRAS or KRAS). Results We included 214 cases. There were 117 (54.7%) cases of BRAFV600E and 97 (45.3%) cases of RAS-like mutations. The BRAFV600E group was statistically associated with a smaller mean tumor size when compared with the RAS group of 1.55 cm and 2.04 cm, respectively. In a multivariate model, tumors with BRAFV600E mutations were also more likely to display aggressive pathological features, including extra-thyroidal extension, lymph node metastasis, columnar cell features, tall cell histology, or hobnail histology (OR 26.69; 95% CI 11.15–70.81). In contrast, tumor size was not associated with pathologic aggressive features on multivariate analysis (OR 0.81; 95% CI 0.54–1.22). Conclusion This study demonstrates that thyroid tumors expressing BRAFV600E mutations correlate with aggressive pathologic features more than tumors expressing RAS-like mutations. When comparing tumors with BRAFV600E and RAS-like mutations, the former were found to be smaller. As a result of this finding, this study suggests that molecular alterations may better predict aggressive pathologic features than the size of the tumor. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-022-00559-9.
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Affiliation(s)
| | - Grégoire B Morand
- Faculty of Medicine, McGill University, Montréal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1E2, Canada
| | | | - Sabrina D da Silva
- Faculty of Medicine, McGill University, Montréal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1E2, Canada
| | - Véronique-Isabelle Forest
- Faculty of Medicine, McGill University, Montréal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1E2, Canada
| | - Michael P Hier
- Faculty of Medicine, McGill University, Montréal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1E2, Canada
| | - Marc P Pusztaszeri
- Faculty of Medicine, McGill University, Montréal, QC, Canada.,Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Michael Tamilia
- Faculty of Medicine, McGill University, Montréal, QC, Canada.,Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Richard J Payne
- Faculty of Medicine, McGill University, Montréal, QC, Canada. .,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1E2, Canada.
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168
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Abstract
In the evaluation of thyroid nodules, cytopathology of thyroid fine-needle aspiration specimens plays a central role. Established classification schemes should be used. In the case of indeterminate cytology, additional molecular tests may be used. However, the stratification of indeterminate thyroid nodules into malignant and benign lesions based on molecular tests alone, apart from costly commercial assays from US vendors, has so far been clearly limited. Molecular testing of single genetic alterations that can confirm malignancy in papillary, poorly differentiated, and anaplastic thyroid carcinomas is helpful and relatively easy to perform. However, negative test results by no means exclude malignant neoplasia. Predictive markers for single entities (BRAF V600E, RET mutations and RET fusions) should be tested in all advanced thyroid carcinomas.
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Affiliation(s)
- O Chijioke
- Institut für Pathologie, Universitätsspital Basel, Schönbeinstraße 40, 4031, Basel, Schweiz.
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169
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Heidari Z, Valinezhad M. High prevalence of parvovirus B19 infection in patients with thyroid nodules: A case-control study. Am J Otolaryngol 2022; 43:103345. [PMID: 34995966 DOI: 10.1016/j.amjoto.2021.103345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The incidence of thyroid nodules has increased dramatically in recent decades. Although this increase has been attributed to improved imaging modalities, the question arises as to whether other environmental factors, such as infectious agents are influential. METHODS Adult patients with newly diagnosed papillary thyroid carcinoma, benign thyroid nodules, and healthy euthyroid controls without nodules; were recruited. Various clinical and biochemical parameters including thyroid function tests and serum Parvovirus B19 Ab (IgG) were assessed and compared between groups. RESULTS In this study, data from 364 patients with papillary thyroid carcinoma, 370 patients with benign thyroid nodules, and 360 healthy euthyroid individuals without nodules were analyzed as a control group. The prevalence of parvovirus B19 infection in papillary thyroid carcinoma patients was 58.8% that was significantly higher than the two groups of benign thyroid nodules (49.2%) and the control group (45.0%). In the papillary thyroid carcinoma group, a significant positive correlation was found between tumor size and TSH (r = 0.129, p = 0.014), and between tumor size and B19-Ab (r = 0.176, p = 0.001). CONCLUSION The rate of parvovirus B19 infection was higher in patients with papillary thyroid carcinoma and benign thyroid nodules than in the control group. Also, patients with papillary thyroid carcinoma had significantly higher rates of B19 infection than those with benign thyroid nodules.
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170
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Yao J, Zhang W, Wang J, Wang K, Lv C, Zhang Z, Chen X, Chen Y, Jiang W, Niu J, Song F, Liu P, Sun D. The Status of Iodine Nutrition after Removing Iodized Salt in High Water Iodine Regions: a Cross-sectional Study in China. Biol Trace Elem Res 2022; 200:1020-1031. [PMID: 33929694 DOI: 10.1007/s12011-021-02727-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
Currently, the removal of iodized salt is carried out in high water iodine regions. The present situation of iodine nutrition and the prevalence of thyroid diseases in such regions have not been clearly elucidated. This study aimed to figure out these problems to help render effective measures for cases of abnormal iodine nutrition status. A cross-sectional study was carried out in four areas of Jining and Heze, Shandong Province, China, with different water iodine concentrations (WIC). In total, 1344 adults were enrolled in this study, and data related to their iodine nutrition, thyroid function, and thyroid ultrasonography were collected. Subjects were grouped according to WIC, urine iodine concentration (UIC), serum iodine concentration (SIC), and combined UIC and SIC for analysis. Iodine levels were in excess in the 100 μg/L ≤ WIC < 300 μg/L and WIC ≥ 300 μg/L areas. Compared with the control WIC group (10-100 μg/L), the WIC ≥ 300 μg/L group had a higher prevalence of thyroid autoimmunity (TAI, 21.25% vs. 13.19%, P <0.05), subclinical hypothyroidism (SH, 20.20% vs. 11.96%, P < 0.05), thyroid nodules (TN, 31.75% vs. 18.71%, P < 0.05), and thyroid dysfunction (23.62% vs. 12.26%, P < 0.05). Compared with the UIC control group (100-300 μg/L), high UIC group (≥ 800 μg/L) had a higher prevalence of TN (33.75% vs. 21.14%, P < 0.05) and thyroid dysfunction (25% vs. 14.47%, P < 0.05). Next, compared with the control SIC group (50-110 μg/L), high SIC group (≥ 110 μg/L) had a higher prevalence of TAI (33.80% vs. 14.47%, P < 0.05), SH (23.94% vs. 14.30%, P < 0.05), and thyroid dysfunction (33.80% vs. 15.29%, P < 0.05). Finally, subjects with the highest UIC and the highest SIC also had a higher prevalence of TAI (25.92% vs. 10.97%, P < 0.05), SH (23.45% vs. 10.97%, P < 0.05), TN (34.56% vs. 15.85%, P < 0.05), and thyroid dysfunction (27.16% vs. 13.41%, P < 0.05) than subjects with middle iodine levels. The iodine nutrition of subjects in the WIC ≥ 300 μg/L areas was still in excess after removing iodized salt from their diets. High levels of iodine also increased the prevalence of TAI, SH, TN, and thyroid dysfunction in those areas. Simply removing iodized salt may not be sufficient for high water iodine regions.
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Affiliation(s)
- J Yao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - W Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - J Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - K Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - C Lv
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Z Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - X Chen
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Y Chen
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - W Jiang
- Institute of Endemic Disease Control, Jinan, Shandong Province, China
| | - J Niu
- Heze Center for Disease Control and Prevention, Heze, China
| | - F Song
- Jining Center for Disease Control and Prevention, Jining, China
| | - P Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - D Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.
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de Koster EJ, Noortman WA, Mostert JM, Booij J, Brouwer CB, de Keizer B, de Klerk JMH, Oyen WJG, van Velden FHP, de Geus-Oei LF, Vriens D. Quantitative classification and radiomics of [ 18F]FDG-PET/CT in indeterminate thyroid nodules. Eur J Nucl Med Mol Imaging 2022; 49:2174-2188. [PMID: 35138444 PMCID: PMC9165273 DOI: 10.1007/s00259-022-05712-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate whether quantitative [18F]FDG-PET/CT assessment, including radiomic analysis of [18F]FDG-positive thyroid nodules, improved the preoperative differentiation of indeterminate thyroid nodules of non-Hürthle cell and Hürthle cell cytology. METHODS Prospectively included patients with a Bethesda III or IV thyroid nodule underwent [18F]FDG-PET/CT imaging. Receiver operating characteristic (ROC) curve analysis was performed for standardised uptake values (SUV) and SUV-ratios, including assessment of SUV cut-offs at which a malignant/borderline neoplasm was reliably ruled out (≥ 95% sensitivity). [18F]FDG-positive scans were included in radiomic analysis. After segmentation at 50% of SUVpeak, 107 radiomic features were extracted from [18F]FDG-PET and low-dose CT images. Elastic net regression classifiers were trained in a 20-times repeated random split. Dimensionality reduction was incorporated into the splits. Predictive performance of radiomics was presented as mean area under the ROC curve (AUC) across the test sets. RESULTS Of 123 included patients, 84 (68%) index nodules were visually [18F]FDG-positive. The malignant/borderline rate was 27% (33/123). SUV-metrices showed AUCs ranging from 0.705 (95% CI, 0.601-0.810) to 0.729 (0.633-0.824), 0.708 (0.580-0.835) to 0.757 (0.650-0.864), and 0.533 (0.320-0.747) to 0.700 (0.502-0.898) in all (n = 123), non-Hürthle (n = 94), and Hürthle cell (n = 29) nodules, respectively. At SUVmax, SUVpeak, SUVmax-ratio, and SUVpeak-ratio cut-offs of 2.1 g/mL, 1.6 g/mL, 1.2, and 0.9, respectively, sensitivity of [18F]FDG-PET/CT was 95.8% (95% CI, 78.9-99.9%) in non-Hürthle cell nodules. In Hürthle cell nodules, cut-offs of 5.2 g/mL, 4.7 g/mL, 3.4, and 2.8, respectively, resulted in 100% sensitivity (95% CI, 66.4-100%). Radiomic analysis of 84 (68%) [18F]FDG-positive nodules showed a mean test set AUC of 0.445 (95% CI, 0.290-0.600) for the PET model. CONCLUSION Quantitative [18F]FDG-PET/CT assessment ruled out malignancy in indeterminate thyroid nodules. Distinctive, higher SUV cut-offs should be applied in Hürthle cell nodules to optimize rule-out ability. Radiomic analysis did not contribute to the additional differentiation of [18F]FDG-positive nodules. TRIAL REGISTRATION NUMBER This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544 .
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Wyanne A Noortman
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
| | - Jacob M Mostert
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Delft University of Technology, Delft, the Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | | | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
| | - Floris H P van Velden
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Jiang L, Liu D, Long L, Chen J, Lan X, Zhang J. Dual-source dual-energy computed tomography-derived quantitative parameters combined with machine learning for the differential diagnosis of benign and malignant thyroid nodules. Quant Imaging Med Surg 2022; 12:967-978. [PMID: 35111598 DOI: 10.21037/qims-21-501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023]
Abstract
Background This study aimed to investigate the ability of quantitative parameter-derived dual-source dual-energy computed tomography (DS-DECT) combined with machine learning to distinguish between benign and malignant thyroid nodules. Methods Patients with thyroid nodules and pathological surgical results who underwent preoperative DS-DECT were selected. Quantitative parameter-derived DS-DECT was applied to classify benign and malignant nodules. Then, machine learning and binary logistic regression analysis models were constructed using the DS-DECT quantitative parameters to distinguish between benign and malignant nodules. The receiver operating characteristic curve was used to assess the diagnostic performance. The DeLong test was used to compare the diagnostic efficacy. Results One hundred and thirty patients with 139 confirmed thyroid nodules were involved in the study. The malignant group had a significantly higher iodine concentrationnodule (arterial phase) (P=0.001), normalized iodine concentration (arterial phase) (P=0.002), iodine concentration difference (P<0.001), spectral curve slope (nonenhancement) (P=0.007), spectral curve slope (arterial phase) (P=0.001), effective atomic number (nonenhancement) (P<0.001), and effective atomic number (arterial phase) (P=0.039) than the benign group. The binary logistic regression analysis model had an AUC (area under the curve) of 0.76, a sensitivity of 0.821, and a specificity of 0.667. The machine learning model had an AUC of 0.86, a sensitivity of 0.822, specificity of 0.791 in the training cohort, an AUC of 0.84, a sensitivity of 0.727, and specificity of 0.750 in the testing cohort. Conclusions Multiple quantitative parameters of DS-DECT combined with machine learning could differentiate between benign and malignant thyroid nodules.
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Affiliation(s)
- Liling Jiang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Ling Long
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiao Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
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173
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Ghaznavi SA, Clayton H, Eszlinger M, Khalil M, Symonds CJ, Paschke R. Accuracy of Thyroid Fine-Needle Aspiration Cytology: A Cyto-Histologic Correlation Study in an Integrated Canadian Health Care Region with Centralized Pathology Service. Acta Cytol 2022; 66:171-178. [PMID: 35108713 DOI: 10.1159/000521562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/13/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The reported ROM within TBSRTC categories varies widely and depends on several factors in the clinical care pathway for thyroid nodules, including sonographic risk stratification, cytology expertise, selection criteria for surgical resection, and definitions of malignancy used. METHODS We present 5,867 consecutive thyroid FNAC and corresponding surgical pathology in the context of a comprehensive, single-payer health care system with centralized cytology and surgical pathology services for over 1.5 million inhabitants. RESULTS We report higher usage of ND and AUS/FLUS categories than the literature (19% vs. <10% and 15% vs. <10%, respectively). Our surgical resection rate for malignant cytology is substantially higher than the literature (94% vs. 50%, respectively). The ROM by the TBSRTC category in our cohort was similar to the literature. The overall diagnostic accuracy of thyroid FNAC was 92%, which is similar to other studies. Inclusion of incidental PMC as histologically malignant raised the ROM in the ND, benign, and AUS/FLUS categories. DISCUSSION The diagnostic performance of thyroid FNAC in our study is similar to the reported literature. Differences in TBSRTC category usage likely arise from cytologist variability and expertise. Our higher surgical resection rate in the malignant cytology category reflects the greater capture of surgical follow-up within our healthcare region with centralized pathology and a single EMR system. Keeping in mind the method of calculation of ROM, the malignancy rate by TBSRTC is similar to previous reports.
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Affiliation(s)
- Sana A Ghaznavi
- Division of Endocrinology & Metabolism, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hailey Clayton
- Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Markus Eszlinger
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Moosa Khalil
- Department of Pathology & Laboratory Medicine and Calgary Laboratory Services, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Christopher J Symonds
- Division of Endocrinology & Metabolism, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ralf Paschke
- Division of Endocrinology & Metabolism, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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174
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Agretti P, De Marco G, Ferrarini E, Di Cosmo C, Montanelli L, Bagattini B, Chiovato L, Tonacchera M. Gene expression profile in functioning and non-functioning nodules of autonomous multinodular goiter from an area of iodine deficiency: unexpected common characteristics between the two entities. J Endocrinol Invest 2022; 45:399-411. [PMID: 34405392 PMCID: PMC8783917 DOI: 10.1007/s40618-021-01660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Toxic multinodular goiter is a heterogeneous disease associated with hyperthyroidism frequently detected in areas with deficient iodine intake, and functioning and non-functioning nodules, characterized by increased proliferation but opposite functional activity, may coexist in the same gland. To understand the distinct molecular pathology of each entity present in the same gland, the gene expression profile was evaluated by using the Affymetrix technology. METHODS Total RNA was extracted from nodular and healthy tissues of two patients and double-strand cDNA was synthesized. Biotinylated cRNA was obtained and, after chemical fragmentation, was hybridized on U133A and B arrays. Each array was stained and the acquired images were analyzed to obtain the expression levels of the transcripts. Both functioning and non-functioning nodules were compared versus healthy tissue of the corresponding patient. RESULTS About 16% of genes were modulated in functioning nodules, while in non-functioning nodules only 9% of genes were modulated with respect to the healthy tissue. In functioning nodules of both patients and up-regulation of cyclin D1 and cyclin-dependent kinase inhibitor 1 was observed, suggesting the presence of a possible feedback control of proliferation. Complement components C1s, C7 and C3 were down-regulated in both types of nodules, suggesting a silencing of the innate immune response. Cellular fibronectin precursor was up-regulated in both functioning nodules suggesting a possible increase of endothelial cells. Finally, Frizzled-1 was down-regulated only in functioning nodules, suggesting a role of Wnt signaling pathway in the proliferation and differentiation of these tumors. None of the thyroid-specific gene was deregulated in microarray analysis. CONCLUSION In conclusion, the main finding from our data is a similar modulation for both kinds of nodules in genes possibly implicated in thyroid growth.
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Affiliation(s)
- P Agretti
- Endocrinology Unit 1, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G De Marco
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - E Ferrarini
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Di Cosmo
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Montanelli
- Endocrinology Unit 1, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - B Bagattini
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, IRCCS Maugeri, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - M Tonacchera
- Endocrinology Unit 1, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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175
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Kim K, Bae JS, Kim JS, Jung SL, Jung CK. Diagnostic Performance of Thyroid Core Needle Biopsy Using the Revised Reporting System: Comparison with Fine Needle Aspiration Cytology. Endocrinol Metab (Seoul) 2022; 37:159-169. [PMID: 35255608 PMCID: PMC8901962 DOI: 10.3803/enm.2021.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We aim to validate the diagnostic performance of thyroid core needle biopsy (CNB) for diagnosing malignancy in clinical settings to align with the changes made in recently updated thyroid CNB guidelines. METHODS We retrospectively analyzed 1,381 thyroid CNB and 2,223 fine needle aspiration (FNA) samples. The FNA and CNB slides were interpreted according to the Bethesda System for Reporting Thyroid Cytopathology and updated practice guidelines for thyroid CNB, respectively. RESULTS Compared to FNA, CNB showed lower rates of inconclusive results categories I (2.8% vs. 11.2%) and III (1.2% vs. 6.2%), and higher rates of categories II (60.9% vs. 50.4%) and IV (17.5% vs. 2.0%). The upper and lower bounds of the risk of malignancy (ROM) for category IV of CNB were 43.2% and 26.6%, respectively. The CNB subcategory IVb with nuclear atypia had a higher ROM than the subcategory without nuclear atypia (40%-62% vs. 23%-36%). In histologically confirmed cases, there was no significant difference in the diagnostic performance between CNB and FNA for malignancy. However, neoplastic diseases were more frequently detected by CNB than by FNA (88.8% vs. 77.6%, P=0.046). In category IV, there was no difference in unnecessary surgery rate between CNB and FNA (4.7% vs. 6.9%, P=0.6361). CONCLUSION Thyroid CNB decreased the rate of inconclusive results and showed a higher category IV diagnostic rate than FNA. The revised guidelines for thyroid CNB proved to be an excellent reporting system for assessing thyroid nodules.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - So Lyung Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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176
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Du Y, Bara M, Katlariwala P, Croutze R, Resch K, Porter J, Sam M, Wilson MP, Low G. Effect of training on resident inter-reader agreement with American College of Radiology Thyroid Imaging Reporting and Data System. World J Radiol 2022; 14:19-29. [PMID: 35126875 PMCID: PMC8788165 DOI: 10.4329/wjr.v14.i1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) was introduced to standardize the ultrasound characterization of thyroid nodules. Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations. Despite its widespread adoption, there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience. We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TI-RADS, a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.
AIM To evaluate the inter-reader agreement of radiology residents in using ACR TI-RADS before and after training.
METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed. Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each. Three PGY-4 radiology residents (trainees) were selected as blinded readers for this study. Each trainee had between 4 to 5 mo of designated ultrasound training. No trainee had received specialized TI-RADS training prior to this study. Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart. Fleiss kappa was used to measure the pooled inter-reader agreement. The relative diagnostic performance of readers, pre- and post-training, when compared against the reference standard.
RESULTS There were 33 females and 7 males with a mean age of 56.6 ± 13.6 years. The mean nodule size was 19 ± 14 mm (range from 5 to 63 mm). A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables: 1. “Shape” (k of 0.09 [slight] pre-training vs 0.67 [substantial] post-training, P < 0.001), 2. “Echogenic foci” (k of 0.28 [fair] pre-training vs 0.45 [moderate] post-training, P = 0.004), 3. ‘TI-RADS level’ (k of 0.14 [slight] pre-training vs 0.36 [fair] post-training, P < 0.001) and 4. ‘Recommendations’ (k of 0.36 [fair] pre-training vs 0.50 [moderate] post-training, P = 0.02). No significant differences between the pre- and post-training assessments were found for the variables 'composition', 'echogenicity' and 'margins'. There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high (76.6%-96.8%) for all TI-RADS level.
CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed. Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
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Affiliation(s)
- Yang Du
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Meredith Bara
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Prayash Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Roger Croutze
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Katrin Resch
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Jonathan Porter
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
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177
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Abstract
This study evaluated how to manage Bethesda category III (Bethesda III) (atypia of undetermined significance/follicular lesion of undetermined significance [AUS/FLUS]) thyroid nodules according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) to reduce unnecessary surgeries. A total of 161 thyroid nodules diagnosed as Bethesda III underwent surgery from 2016 to 2019. Ultrasonography-guided fine-needle aspiration (US-FNA) or core needle biopsy (CNB) was used for repeat examination. K-TIRADS category was assigned to the thyroid nodules. The proportion of malignancy in Bethesda III nodules confirmed by surgery were significantly increased in proportion relative to K-TIRADS with 60.0% low suspicion, 88.2% intermediate suspicion, and 100% high suspicion nodules (p < 0.001). The proportion of malignancy in AUS and FLUS were significantly different (94.2% vs. 40.0% p = 0.003). The proportion of malignancy in AUS increased with K-TIRADS categories, but there was no difference in FLUS. All K-TIRADS high suspicion nodules were AUS as papillary carcinomas (99%), while 80% of FLUS nodules and 50% of follicular carcinomas showed K-TIRADS low suspicion. In 116 nodules with repeat FNA or CNB after initial Bethesda III results, the conclusive result rate was significantly increased in proportion to K-TIRADS with 58.3% low suspicion, 83.3% intermediate suspicion, and 88.8% high suspicion nodules (p = 0.015). K-TIRADS low suspicion nodules of Bethesda III nodules should be managed after risk-benefit consideration rather than immediate surgery or repeat examination. K-TIRADS for Bethesda III nodules can predict papillary carcinoma well, but not follicular carcinoma.
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Affiliation(s)
- Jieun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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178
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Hargitai L, Schefner M, Traub-Weidinger T, Haug A, Arikan M, Scheuba C, Riss P. Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism. Langenbecks Arch Surg 2022; 407:1183-1191. [PMID: 35061094 PMCID: PMC9151570 DOI: 10.1007/s00423-022-02442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
Purpose Curative treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy (PTX) with removal of the hyperfunctioning gland(s). In an endemic goitre region, 35–78% of PHPT patients show concomitant thyroid disease. This study aimed to evaluate if 99mTc-sestamibi (MIBI)-positive thyroid nodules decrease sensitivity in regard to localising the hyperfunctioning parathyroid gland(s) in PHPT patients. Methods Within 5 years, 497 consecutive patients with biochemically proven PHPT were included in this study. The data was analysed retrospectively. Results In total, 198 patients underwent PTX with thyroid surgery and 299 patients underwent sole PTX. Sensitivity of MIBI scan for PTX with and without thyroid surgery was 72.1% and 73.6%, respectively. A statistically significant difference in sensitivity of ultrasound for PTX with and without thyroid surgery (57.0% and 70.9%, respectively) was observed (p = 0.029). Thyroid nodule histology did not have a significant effect on the MIBI scan. Unilateral neck exploration (UNE) was performed in 110 patients and bilateral neck exploration (BNE) in 177 patients. The probability of surgical conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules. Conclusions Concomitant benign thyroid nodules did not influence MIBI sensitivity. No correlation between thyroid carcinoma and MIBI uptake was determined. However, MIBI detection of thyroid malignancy is important in patients initially being considered for minimal invasive parathyroidectomy. Sensitivity and positive predictive value of ultrasound were significantly lower in patients with thyroid nodules. The probability of conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules.
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Affiliation(s)
- Lindsay Hargitai
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
| | - Maria Schefner
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Alexander Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Melisa Arikan
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christian Scheuba
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Philipp Riss
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
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179
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Alexander EK. Novel Genomic Roadmaps and Their Clinical Translation Ahead. J Clin Endocrinol Metab 2022; 107:e886-e887. [PMID: 34131747 PMCID: PMC8764213 DOI: 10.1210/clinem/dgab423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Erik K Alexander
- Chief, Thyroid Section, Brigham & Women’s Hospital; Professor of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: Erik K. Alexander, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.
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de Koster EJ, de Geus-Oei LF, Brouwers AH, van Dam EWCM, Dijkhorst-Oei LT, van Engen-van Grunsven ACH, van den Hout WB, Klooker TK, Netea-Maier RT, Snel M, Oyen WJG, Vriens D. [ 18F]FDG-PET/CT to prevent futile surgery in indeterminate thyroid nodules: a blinded, randomised controlled multicentre trial. Eur J Nucl Med Mol Imaging 2022; 49:1970-1984. [PMID: 34981165 PMCID: PMC9016050 DOI: 10.1007/s00259-021-05627-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 01/21/2023]
Abstract
Purpose To assess the impact of an [18F]FDG-PET/CT-driven diagnostic workup to rule out malignancy, avoid futile diagnostic surgeries, and improve patient outcomes in thyroid nodules with indeterminate cytology. Methods In this double-blinded, randomised controlled multicentre trial, 132 adult euthyroid patients with scheduled diagnostic surgery for a Bethesda III or IV thyroid nodule underwent [18F]FDG-PET/CT and were randomised to an [18F]FDG-PET/CT-driven or diagnostic surgery group. In the [18F]FDG-PET/CT-driven group, management was based on the [18F]FDG-PET/CT result: when the index nodule was visually [18F]FDG-positive, diagnostic surgery was advised; when [18F]FDG-negative, active surveillance was recommended. The nodule was presumed benign when it remained unchanged on ultrasound surveillance. In the diagnostic surgery group, all patients were advised to proceed to the scheduled surgery, according to current guidelines. The primary outcome was the fraction of unbeneficial patient management in one year, i.e., diagnostic surgery for benign nodules and active surveillance for malignant/borderline nodules. Intention-to-treat analysis was performed. Subgroup analyses were performed for non-Hürthle cell and Hürthle cell nodules. Results Patient management was unbeneficial in 42% (38/91 [95% confidence interval [CI], 32–53%]) of patients in the [18F]FDG-PET/CT-driven group, as compared to 83% (34/41 [95% CI, 68–93%]) in the diagnostic surgery group (p < 0.001). [18F]FDG-PET/CT-driven management avoided 40% (25/63 [95% CI, 28–53%]) diagnostic surgeries for benign nodules: 48% (23/48 [95% CI, 33–63%]) in non-Hürthle cell and 13% (2/15 [95% CI, 2–40%]) in Hürthle cell nodules (p = 0.02). No malignant or borderline tumours were observed in patients under surveillance. Sensitivity, specificity, negative and positive predictive value, and benign call rate (95% CI) of [18F]FDG-PET/CT were 94.1% (80.3–99.3%), 39.8% (30.0–50.2%), 95.1% (83.5–99.4%), 35.2% (25.4–45.9%), and 31.1% (23.3–39.7%), respectively. Conclusion An [18F]FDG-PET/CT-driven diagnostic workup of indeterminate thyroid nodules leads to practice changing management, accurately and oncologically safely reducing futile surgeries by 40%. For optimal therapeutic yield, application should be limited to non-Hürthle cell nodules. Trial registration number This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05627-2.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Eveline W C M van Dam
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, the Netherlands
| | | | | | - Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Tamira K Klooker
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marieke Snel
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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181
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Wang S, Wang X, Hua X, Jiang S, Xie Y, Liu H. Adjusted association between type 2 immunity and low risk thyroid nodules: a retrospective cohort study. BMC Endocr Disord 2022; 22:2. [PMID: 34983483 PMCID: PMC8725489 DOI: 10.1186/s12902-021-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immune responses, especially type 2 immunity, might be related to the prevalence of thyroid nodules, while the key regulators and potential pathways are remaining largely unknown. In addition, the immune status of individuals could be affected by mixed metabolic background. Herein our aim was to investigate the adjusted association between ultrasound-diagnosed low risk thyroid nodules and immune responses, excluding the interference of metabolic effects on immunity. METHODS We retrospectively enrolled 1764 subjects who underwent a thorough thyroid ultrasound examination. To eliminate the interference of confounders, we used propensity score matching (PSM) to match age, gender, cigarette smoking and alcohol drinking, parameters that are related with metabolic syndrome (MetS). Then the potential effectors of immune responses involved in the laboratorial assays were evaluated. Binary logistic regression analysis was used to assess the independent predictors of thyroid nodules in a multivariate manner. RESULTS The 1172 subjects were remained after PSM, and differences of demographic background between subjects with and without thyroid nodules were eliminated. Metabolic parameters comprising blood pressure, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein and serum uric acid were shown no significant difference between post-PSM subjects with and without thyroid nodules. Among the biochemistry and hematological parameters, white blood cell count and the positive rate of eosinophil percentage were increased in subjects with thyroid nodules than in those without thyroid nodules. In contrast, the positive rate of basophil percentage was lower in subjects with thyroid nodules than in those without thyroid nodules. In addition, the thyroid function test results showed that subjects with thyroid nodules had higher positive rates of antithyroglobulin antibody (TgAb) and antithyroid peroxidase antibody (TPOAb) than subjects without thyroid nodules. The logistic regression analysis indicated that the positive value of TgAb as well as high level of white blood cell count and BMI could serve as independent risk factors of thyroid nodules. CONCLUSIONS The type 2 immune responses mediated by increased level of eosinophils, along with positive value of TgAb and TPOAb were associated with the presence of thyroid nodules. In addition, the potential role of basophils in protecting against thyroid nodules and the pathogenesis of immune-metabolic status remains to be elucidated.
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Affiliation(s)
- Sanxing Wang
- Department of Laboratory Medicine, the Second Medical Centre, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xia Wang
- State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Xiang Hua
- State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Shichao Jiang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yong Xie
- State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005, China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Hongying Liu
- Department of Laboratory Medicine, the Second Medical Centre, Chinese PLA General Hospital, Beijing, 100853, China.
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182
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Joo L, Na DG, Kim JH, Seo H. Comparison of Core Needle Biopsy and Repeat Fine-Needle Aspiration in Avoiding Diagnostic Surgery for Thyroid Nodules Initially Diagnosed as Atypia/Follicular Lesion of Undetermined Significance. Korean J Radiol 2022; 23:280-288. [PMID: 35029081 PMCID: PMC8814697 DOI: 10.3348/kjr.2021.0619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/19/2021] [Accepted: 10/14/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To compare core needle biopsy (CNB) and repeat fine-needle aspiration (rFNA) to reduce the rate of diagnostic surgery and prevent unnecessary surgery in nodules initially diagnosed as atypia/follicular lesions of undetermined significance (AUS/FLUS). Materials and Methods This study included 231 consecutive patients (150 female and 81 male; mean age ± standard deviation, 51.9 ± 11.7 years) with 235 thyroid nodules (≥ 1 cm) initially diagnosed as AUS/FLUS, who later underwent both rFNA and CNB. The nodules that required diagnostic surgery after the biopsy were defined using three different scenarios according to the rFNA and CNB results: criterion 1, surgery for low-risk indeterminate (categories I and III); criterion 2, surgery for high-risk indeterminate (categories IV and V); and criterion 3, surgery for all indeterminate nodules (categories I, III, IV, and V). We compared the expected rates of diagnostic surgery between CNB and rFNA in all 235 nodules using the three surgical criteria. In addition, the expected rates of unnecessary surgery (i.e., surgery for benign pathology) were compared in a subgroup of 182 nodules with available final diagnoses. Results CNB showed significantly lower rates of nondiagnostic, AUS/FLUS, and suspicious for malignancy diagnoses (p ≤ 0.016) and higher rates of follicular neoplasm or suspicious for a follicular neoplasm (p < 0.001) and malignant diagnoses (p = 0.031). CNB showed a significantly lower expected rate of diagnostic surgery than rFNA for criterion 1 (29.8% vs. 48.1%, p < 0.001) and criterion 3 (46.4% vs. 55.3%, p = 0.029), and a significantly higher rate for criterion 2 (16.6% vs. 7.2%, p = 0.001). CNB showed a significantly lower expected rate of unnecessary surgery than rFNA for criterion 1 (18.7% vs. 29.7%, p = 0.024). Conclusion CNB was superior to rFNA in reducing the rates of potential diagnostic surgery and unnecessary surgery for nodules initially diagnosed as AUS/FLUS in a scenario where nodules with low-risk indeterminate results (categories I and III) would undergo surgery.
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Affiliation(s)
- Leehi Joo
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea.
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyobin Seo
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea
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183
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Yang GE, Na DG. Impact of the ultrasonography assessment method on the malignancy risk and diagnostic performance of five risk stratification systems in thyroid nodules. Endocrine 2022; 75:137-148. [PMID: 34533767 DOI: 10.1007/s12020-021-02795-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE Ultrasonographic (US) assessment methods may affect the estimated malignancy risk of thyroid nodules. This study aimed to investigate the impact of retrospective and prospective US assessments on the estimated malignancy risk of US features, classified categories, and diagnostic performance of five risk stratification systems (RSSs) in thyroid nodules. METHODS A total of 3685 consecutive thyroid nodules (≥1 cm) with final diagnoses (retrospective dataset, n = 2180; prospective dataset, n = 1505) were included in this study. We compared the estimated malignancy risk of US features, classified categories, and diagnostic performances of the five common RSSs between retrospective (static US images without cine clips) and prospective datasets of real-time US assessment. RESULTS There was no significant difference in the prevalence and histological type of malignant tumours between the two datasets (p ≥ 0.216). The malignancy risk of solid composition and nonparallel orientation was higher and that of microcalcification was lower in the prospective dataset than in the retrospective dataset (p < 0.001, p = 0.018, p = 0.007, respectively). The retrospective US assessment showed slightly higher malignancy risk of intermediate- or high-risk nodules according to the RSSs. Prospective US assessment showed lower specificities and higher unnecessary biopsy rates by all RSSs compared to the retrospective US assessment (p ≤ 0.006, p ≤ 0.045, respectively). CONCLUSIONS The retrospective US assessment showed higher malignancy risk of microcalcification and some classified categories by RSSs, and overestimated the specificities and underestimated the unnecessary biopsy rates by all RSSs compared to prospective US assessment.
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Affiliation(s)
- Go Eun Yang
- Department of Radiology, School of medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
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Shayganfar A, Azin N, Hashemi P, Ghanei AM, Hajiahmadi S. Diagnostic Accuracy of Multiple MRI Parameters in Dealing with Incidental Thyroid Nodules. SN Compr Clin Med 2022; 4:228. [PMID: 36275123 PMCID: PMC9579554 DOI: 10.1007/s42399-022-01307-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
Background Different MRI parameters have been studied for evaluating thyroid nodules. Diffusion-weighted imaging (DWI) and T2 imaging sequences with considerable efficacy in evaluating soft tissue tumors merit further assessment for thyroid nodule investigation. Method We evaluated incidental thyroid nodules (ITNs) reported on head and neck MRI studies. The T2 signal intensity (SI), T2 signal intensity ratio (SIR), Z value, and apparent diffusion coefficient (ADC) values of the thyroid nodule were obtained for every patient. The patients were referred to the radiology department for the thyroid nodule ultrasound study. Finally, 33 participants (37 thyroid nodules) who were scheduled for fine needle aspiration and cytology (FNAC) were enrolled. Regarding the FNAC results, the nodules were divided into malignant and benign groups. The two groups’ MRI parameters were compared using a two samples independent t test, and the cutoff values were estimated by analyzing the receiver operating characteristics plot. Results The T2 signal intensities, SIR, Z values, and ADC values were significantly higher in the benign group than malignant. The cutoff points of 230 (AUC = 0.759), 3.38 (AUC = 0.754), 37 (AUC = 0.759), and 1.73 (AUC = .690) were obtained for T2 values, SIR, Z values, and ADC values, respectively. Conclusion T2, SIR, Z, and ADC values are reliable for discriminating benign from malignant ITNs. However, further studies with a larger sample size are needed to provide more accurate mean values, identify outliers, and reduce confounding factors and bias.
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Affiliation(s)
- Azin Shayganfar
- grid.411036.10000 0001 1498 685XDepartment of Radiology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
| | - Neda Azin
- grid.411036.10000 0001 1498 685XDepartment of Radiology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
| | - Peyman Hashemi
- grid.411036.10000 0001 1498 685XDepartment of Radiology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
| | - Amir Mohammad Ghanei
- grid.411036.10000 0001 1498 685XDepartment of Radiology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
| | - Somayeh Hajiahmadi
- grid.411036.10000 0001 1498 685XDepartment of Radiology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
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185
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Lian KM, Lin T. Role of color-coded virtual touch tissue imaging in suspected thyroid nodules. Technol Health Care 2022; 30:673-682. [PMID: 34511520 DOI: 10.3233/thc-213156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Conventional ultrasound (US) is the most widely used imaging test for thyroid nodule surveillance. OBJECTIVE We used the color-coded virtual touch tissue imaging (VTI) in the Acoustic Radiation Force Impulse (ARFI) technique to assess the hardness of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) TR3-5 nodules. The ability of color-coded VTI (CV) to discriminate between benign and malignant nodules was investigated. METHODS In this retrospective study, US and CV were performed on 211 TR3-5 thyroid lesions in 181 consecutive patients. All nodules were operated on to obtain pathological results. A multivariate logistic regression model was chosen to integrate the data obtained from the US and CV. RESULTS The area under the receiver operating characteristic (ROC) curve for the model was 0.945 (95% CI, 0.914 to 0.976). The cutoff value of predictive probability for diagnosing malignant thyroid nodules was 10.64%, the sensitivity was 94.43%, and the specificity was 83.12%. Through comparing with US and CV, respectively, it had been observed that the regression model had the best performance (all P< 0.001). However, when the US was compared with CV, the difference was not significant (P= 0.3304). CONCLUSIONS A combination of US and CV should be recommended for suspected malignant thyroid nodules in clinical practice.
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Affiliation(s)
- Kai-Mei Lian
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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186
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Xia R, Sun W, Yee J, Sheth S, Slywotzky C, Hodak S, Brandler TC. Do ACR TI-RADS scores demonstrate unique thyroid molecular profiles? Ultrasonography 2021; 41:480-492. [PMID: 35189676 PMCID: PMC9262667 DOI: 10.14366/usg.21130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose The present study aimed to examine the molecular profiles of cytologically indeterminate thyroid nodules stratified by American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) categories and to determine whether certain ultrasonographic features display particular molecular alterations. Methods A retrospective review was conducted of cases from January 1, 2016 to April 1, 2018. Cases with in-house ultrasonography, fine-needle aspiration Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnoses, molecular testing, and surgery were included. All cases were diagnosed as TBSRTC indeterminate categories. The ultrasound studies were retrospectively reviewed and assigned TI-RADS scores (TR1-TR5) by board-certified radiologists. The final diagnoses were determined based on the surgical resection pathology. Binary logistic regression analysis was used to study whether demographic characteristics, TI-RADS levels, and TBSRTC diagnoses were associated with ThyroSeq molecular results. Results Eighty-one cases met the inclusion criteria. RAS mutations were the most common alteration across all TI-RADS categories (TR2 2/2; TR3 10/19, TR4 13/44, and TR5 8/16), and did not stratify with any particular TI-RADS category. Only TR4 and TR5 categories displayed more aggressive mutations such as BRAFV600E; and TERT. ThyroSeq results were positively correlated with thyroid malignancy when non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was categorized in the malignant category (odds ratio [OR], 6.859; P<0.01), but not when NIFTP was removed from the malignancy category. Echogenicity scores were found to be negatively correlated with ThyroSeq results in thyroid nodules (OR, 0.162; P<0.01). Conclusion Higher-risk molecular alterations tended to stratify with the higher TI-RADS categories.
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Affiliation(s)
- Rong Xia
- Department of Pathology, NYU Langone Health, New York, USA
| | - Wei Sun
- Department of Pathology, NYU Langone Health, New York, USA
| | - Joseph Yee
- Department of Radiology, NYU Langone Health, New York, USA
| | - Sheila Sheth
- Department of Radiology, NYU Langone Health, New York, USA
| | | | - Steven Hodak
- Department of Medicine, Division of Endocrinology, NYU Langone Health, New York, USA
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187
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Lee H, Cho YJ, Ha EJ, Moon J, Kim YN, Kim M, Lee KM, An SH. Technical feasibility and efficacy of a standard needle magnetization system for ultrasound needle guidance in thyroid nodule-targeting punctures: a phantom study. Ultrasonography 2021; 41:473-479. [PMID: 35108776 PMCID: PMC9262671 DOI: 10.14366/usg.21211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The aim of this study was to assess the feasibility and efficacy of an ultrasound needle guidance system (NGS) based on standard needle magnetization in a phantom study of thyroid nodule (TN)-targeting punctures. METHODS Six trainees and a staff radiologist performed TN-targeting punctures with or without the NGS in phantom models (group 1, experience <50 cases; group 2, experience ≥50 cases and <100 cases; group 3, experience ≥100 cases of TN-targeting punctures). The feasibility, technical success rate, number of punctures, and procedure time were recorded. RESULTS The feasibility of NGS was 98.6% (138/140). In group 1, the technical success rate increased from 60.0%±8.2% to 80.0%±8.2% when the NGS was used (P=0.046), with a reduction in the number of punctures from 2.2 to 1.2 (P=0.005). In group 2, the rate changed from 95.0%±5.8% to 100.0%±0.0% with the NGS (P=0.157), with a minimal decrease in the number of punctures from 1.1 to 1.0 (P=0.157). The procedure time significantly decreased in both groups (P=0.041 and P=0.010, respectively) when the NGS was used. In group 3, there were no significant differences in the technical success rate and the number of punctures according to whether the NGS was used (P=0.317 and P=0.317, respectively). CONCLUSION NGS using standard needle magnetization is technically feasible and has potential to improve the efficacy of TN-targeting punctures for less-experienced operators, especially beginners, according to the findings of this phantom study.
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Affiliation(s)
- Haein Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Yoon Joo Cho
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jayoung Moon
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - You Na Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Minji Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyung-Min Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Hyun An
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
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188
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Marina M, Zatelli MC, Goldoni M, Del Rio P, Corcione L, Martorana D, Percesepe A, Bonatti F, Mozzoni P, Crociara A, Ceresini G. Combination of ultrasound and molecular testing in malignancy risk estimate of Bethesda category IV thyroid nodules: results from a single-institution prospective study. J Endocrinol Invest 2021; 44:2635-2643. [PMID: 33860907 PMCID: PMC8572191 DOI: 10.1007/s40618-021-01571-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/04/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Malignancy prediction in indeterminate thyroid nodules is still challenging. We prospectively evaluated whether the combination of ultrasound (US) risk stratification and molecular testing improves the assessment of malignancy risk in Bethesda Category IV thyroid nodules. METHODS Ninety-one consecutively diagnosed Bethesda Category IV thyroid nodules were prospectively evaluated before surgery by both ACR- and EU-TIRADS US risk-stratification systems and by a further US-guided fine-needle aspiration cytology (FNAC) for the following molecular testing: BRAFV600E, N-RAS codons 12/13, N-RAS codon 61, H-RAS codons 12/13, H-RAS codon 61, K-RAS codons 12/13, and K-RAS codon 61 point-mutations, as well as PAX8/PPARγ, RET/PC1, and RET/PTC 3 rearrangements. RESULTS At histology, 37% of nodules were malignant. No significant association was found between malignancy and either EU- or ACR-TIRADS. In total, 58 somatic mutations were identified, including 3 BRAFV600E (5%), 5 N-RAS 12/13 (9%), 13 N-RAS 61 (22%), 7 H-RAS 12/13 (12%), 11 H-RAS 61 (19%), 6 K-RAS 12/13 (10%), 8 K-RAS 61 (14%) mutations and 2 RET/PTC1 (4%), 0 RET/PTC 3 (0%), 3 PAX8/PPARγ (5%) rearrangements. At least one somatic mutation was found in 28% and 44% of benign and malignant nodules, respectively, although malignancy was not statistically associated with the outcome of the mutational test. However, the combination of ACR-, but not EU-, TIRADS with the presence of at least one somatic mutation, was significantly associated with malignant histology (P = 0.03). CONCLUSION US risk stratification and FNAC molecular testing may synergistically contribute to improve malignancy risk estimate of Bethesda category IV thyroid nodules.
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Affiliation(s)
- M Marina
- Dipartimento di Medicina e Chirurgia, SSD Medicina Interna Ad Indirizzo Onco-Endocrinologico, Università di Parma-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - M C Zatelli
- Dipartimento di Scienze Mediche, Sezione di Endocrinologia e Medicina Interna, UOL Endocrinologia-Università Degli Studi di Ferrara, Ferrara, Italy
| | - M Goldoni
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - P Del Rio
- UOC Clinica Chirurgica, Università di Parma-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - L Corcione
- UOC Anatomia e Istologia Patologica-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - D Martorana
- UOC Genetica, Università di Parma, Parma, Italy
| | - A Percesepe
- UOC Genetica, Università di Parma, Parma, Italy
| | - F Bonatti
- UOC Oncologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - P Mozzoni
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - A Crociara
- UOC Endocrinologia e Malattie del Ricambio, Azienda Ospedaliero, Universitaria di Ferrara, Ferrara, Italy
| | - G Ceresini
- Dipartimento di Medicina e Chirurgia, SSD Medicina Interna Ad Indirizzo Onco-Endocrinologico, Università di Parma-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Yeste Fernández D, Vega Amenabar E, Coma Muñoz A, Arciniegas Vallejo L, Clemente León M, Planes-Conangla M, Iglesias Felip C, Sábado Álvarez C, Guillén Burrieza G, Campos-Martorell A. Ultrasound criteria (EU-TIRADS) to identify thyroid nodule malignancy risk in adolescents. Correlation with cyto-histological findings. Endocrinol Diabetes Nutr (Engl Ed) 2021; 68:728-734. [PMID: 34924161 DOI: 10.1016/j.endien.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thyroid nodule (TN) harbouring a thyroid carcinoma are more common in paediatric than adult patients. In paediatric population, the evaluation of a TN should require specific paediatric tools for its diagnostic and therapeutic management. High-resolution ultrasonography and cytological evaluation after fine-needle aspiration biopsy (FNAB) remain the cornerstones of evaluation of TN. OBJECTIVES To evaluate in paediatric TN for the first time the usefulness and precision of the ultrasound criteria defined by the "Thyroid Imaging Reporting and Data System (EU-TIRADS) 2017 in adults" to establish the ultrasound indication for the practice of FNAB and stratify the risk of malignancy. PATIENTS AND METHODS 24 paediatric patients under age 18 years with thyroid nodules were attended in the last 15 years, 24 of them (31 nodules; age: 15.2 ± 2.2 years; 18 women) met the inclusion criteria: FNAB with Bethesda classification and ultrasound with EU-TIRADS score. EU-TIRADS score were evaluated retrospectively. Fourteen patients underwent surgery and the definitive histological diagnosis was obtained, this allowed the calculations of sensitivity, specificity and positive and negative predictive values of the EU-TIRADS and Bethesda classification. Data on the largest diameters of the nodules were collected. RESULTS Of the overall 31 nodules, the distribution by EU-TIRADS (T) category was: T1 (3.2%), T2: 2 (6.4%), T3: 7 (22.6%), T4: 16 (51.6%) and T5: 5 (16.1%). All malignant nodules were included in EU-TIRADS category 4 or 5. By the other hand, 13 of the 25 benign nodules were also included in the EU-TIRADS 4 category, and one in the 5. The distribution by categories of Bethesda's classification (B): BI: 6 (19.4%), BII: 14 (45.2%), BIII: 5 (16.1%), BIV: 2 (6.5%), BV: 0 and BVI: 4 (12.9%). The pathological diagnosis of the 14 patients who underwent surgery was: 6 papillary carcinomas and 8 with benign lesions: 6 nodular hyperplasia and 2 follicular adenoma. The percentage of malignancy was 42%. The sensitivity of the EU-TIRADS classification to detect malignant nodules was 100%, the specificity was 25%, PPV 44% and NPV 100%. The sensitivity of the Bethesda classification to detect malignant nodules was 86%, the specificity was 75%, PPV 67% and NPV 90%. The analysis of the largest diameter of the nodules did not show statistically significant differences between benign and malignant lesions. CONCLUSIONS EU-TIRADS for ultrasonographic criteria classification in combination with the clinical history is an adequate and reproducible method to estimate suspicion of malignancy of paediatric TN. It is also a reliable diagnostic tool to decide which nodules will be candidates for FNAB.
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Affiliation(s)
- Diego Yeste Fernández
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain.
| | - Elizabeth Vega Amenabar
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Ana Coma Muñoz
- Servicio Radiología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Larry Arciniegas Vallejo
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - María Clemente León
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Marina Planes-Conangla
- Servicio Radiología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Carmela Iglesias Felip
- Servicio Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Constantino Sábado Álvarez
- Servicio Oncohematología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Gabriela Guillén Burrieza
- Servicio Cirugía Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Ariadna Campos-Martorell
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
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Abstract
PURPOSE Thyroid Bethesda classification system provides 6 diagnostic categories, the first being a sample deemed non-diagnostic or insufficient and requiring a subsequent second biopsy. Our objective was to evaluate differences in non-diagnostic fine needle aspiration (FNA) of thyroid nodules conducted with a 23-gauge(G) needle vs. those conducted with a 25 G needle. METHODS Data from 298 aspiration procedures using either 23 G or 25 G needles were collected, including cytological findings, ultrasound characteristics and patient demographics. The samples were classified as diagnostic or non-diagnostic according to final cytology. RESULTS There was no statistically significant difference between the 25 G and 23 G needles in terms of non-diagnostic rates (35.7%, 31.9%; p = 0.494). Nodules defined as cystic had higher non-diagnostic rates (p < 0.05). Older patients as well as cystic nodules were associated with a higher non-diagnostic rate (OR = 1.018, p = 0.047, OR = 13.533, p = 0.0001, respectively), while nodule size was associated with lower non-diagnostic rates (OR = 0.747, p = 0.017). CONCLUSIONS The use of 25 G needle did not produce a lower non-diagnostic rate when compared to 23 G needle. Larger nodules might increase diagnostic rates, while older patients and cystic nodules are prone to inadequate samples. Patients and caregivers should be aware that FNA of small or cystic nodules as well as nodules in older patients may result in a higher non-diagnostic rate. Further research comparing other needles gauges should be conducted.
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Affiliation(s)
- Sivan Saraph
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hector Cohen
- Department of Pathology, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
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Tuli G, Munarin J, Mussa A, Carli D, Gastaldi R, Borgia P, Vigone MC, Abbate M, Ferrero GB, De Sanctis L. "Thyroid nodular disease and PTEN mutation in a multicentre series of children with PTEN hamartoma tumor syndrome (PHTS)". Endocrine 2021; 74:632-637. [PMID: 34184188 PMCID: PMC8571202 DOI: 10.1007/s12020-021-02805-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the incidence of 4-12% of differentiated thyroid cancer (DTC) and up to 50% of benign thyroid nodular disease and to describe nodular thyroid disease in a multicentre pediatric population with PTEN mutations. METHODS Retrospective data of pediatric patients with PTEN mutations collected from tertiary Departments of Pediatric Endocrinology of Turin, Milan and Genua, Italy, in the period 2010-2020. RESULTS Seventeen children with PTEN mutations were recruited in the study. Thyroid involvement was present in 12/17 (70.6%) subjects, showing a multinodular struma in 6/17 (35.3%), nodules with benign ultrasound features in 5/17 (29.4%) and a follicular adenoma in 1/17 (6%). No correlation was found between thyroid disease and gender, puberty, vascular manifestations, delayed development, or brain MRI abnormalities, while multiple lipomas were associated with thyroid disease (p = 0.03), as was macrocephaly. Standard Deviation (SD) score head circumference was 4.35 ± 1.35 cm in subjects with thyroid disease, 3 ± 0.43 cm (p = 0.02) in the group without thyroid disease. Thyroid involvement was present in all subjects with mutations in exon 6 (4/4) and exon 8 (3/3) of the PTEN gene (p = 0.02). CONCLUSION In the presented cohort, benign thyroid disorders were prevalent, with no evidence of DTC. A correlation was found between thyroid lesions and head circumference and the occurrence of multiple lipomas. Future studies in larger cohorts should assess whether risk stratification is needed when recommending surveillance strategies in children or young adolescents with PTEN hamartoma syndrome.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children Hospital, Turin, Italy.
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Alessandro Mussa
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Diana Carli
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | | | - Paola Borgia
- Department of Paediatrics Gaslini Hospital, Genova, Italy
| | | | - Marco Abbate
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luisa De Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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192
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González Vásquez CM, Muñoz Durán JA, Isaza Zapata S, González Londoño JF, García Gómez V. Concordance of the ACR TI-RADS. Radiologia (Engl Ed) 2021; 63:469-475. [PMID: 34801179 DOI: 10.1016/j.rxeng.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS The ACR TI-RADS classification system is reproducible.
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Affiliation(s)
| | - J A Muñoz Durán
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | - S Isaza Zapata
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | | | - V García Gómez
- Radiólogo, Hospital Pablo Tobón Uribe, Antioquia, Colombia
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193
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Nagasaki K, Shibata N, Nyuzuki H, Sasaki S, Ogawa Y, Soda S, Kogai T, Hishinuma A. A Japanese Family with DICER1 Syndrome Found in Childhood-Onset Multinodular Goitre. Horm Res Paediatr 2021; 93:477-482. [PMID: 33080613 DOI: 10.1159/000511140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Germline DICER1 mutations have recently been identified in familial multinodular goitre (MNG). The natural history of thyroid nodules in DICER1 carriers in children is unclear. The purpose of this study was to describe the clinical and genetic findings of childhood-onset MNG with DICER1 carrier in a patient who underwent total thyroidectomy. CASE PRESENTATION The 6-year-old proband had a thyroid nodule, and the number and size of nodules increased over 3 years. A total thyroidectomy was chosen because of the rapid rise in thyroglobulin levels, discomfort when swallowing, and the mother's history of poorly differentiated thyroid cancer (PDTC). Histopathology revealed adenomatous goitre without malignant cells. Her mother, maternal aunt, and maternal grandmother also had thyroid nodules removed during adolescence. Also, her mother had PDTC with lung metastases, and her maternal aunt had an ovarian germ cell tumour. DICER1 mutation analysis identified a heterozygous novel nonsense mutation (c.4509C>G, p.Y1503X) for the patient, her mother, her maternal grandmother, and her asymptomatic elder brother. Y1503X was identified in all resected thyroid tissues, while heterozygous D1709G, D1810V, and E1813K mutations were identified in individual nodules. DISCUSSION/CONCLUSION A thyroid nodule was detected in chemotherapy- or radiotherapy-naïve patient with DICER1 carrier aged 6 years, and MNG developed over 3 years. This pedigree highlights the natural history of nodular disease in DICER1 carriers and identifies a possible association between DICER1 and more aggressive malignancies.
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Affiliation(s)
- Keisuke Nagasaki
- Division of Paediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan,
| | - Nao Shibata
- Division of Paediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiromi Nyuzuki
- Division of Paediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sunao Sasaki
- Division of Paediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yohei Ogawa
- Division of Paediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoshi Soda
- Department of Endocrinology & Metabolism, Niigata City General Hospital, Niigata, Japan
| | - Takahiko Kogai
- Department of Infection Control and Clinical Laboratory Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Akira Hishinuma
- Department of Infection Control and Clinical Laboratory Medicine, Dokkyo Medical University, Tochigi, Japan
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194
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Mauri G, Papini E, Bernardi S, Barbaro D, Cesareo R, De Feo P, Deandrea M, Fugazzola L, Gambelunghe G, Greco G, Messina C, Monti S, Mormile A, Negro R, Offi C, Palermo A, Persani L, Presciuttini F, Solbiati LA, Spiezia S, Stacul F, Viganò M, Sconfienza LM. Image-guided thermal ablation in autonomously functioning thyroid nodules. A retrospective multicenter three-year follow-up study from the Italian Minimally Invasive Treatment of the Thyroid (MITT) Group. Eur Radiol 2021; 32:1738-1746. [PMID: 34751793 DOI: 10.1007/s00330-021-08289-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy.
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), via Ripamonti 435, Milan, Italy.
| | - Enrico Papini
- Dipartimento Di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Stella Bernardi
- UCO Medicina Clinica, Ospedale Di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Dipartimento Di Scienze Mediche, Università Degli Studi Di Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- Unit of metabolic diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Patophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | | | | | | | - Salvatore Monti
- UOC Di Endocrinologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | | | - Chiara Offi
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Andrea Palermo
- Unit of endocrinology and Diabetes, Campus Bio-Medico university, Roma, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università Degli Studi Di Milano, Milano, Italy
| | | | - Luigi Alessandro Solbiati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Spiezia
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Fulvio Stacul
- SC Radiologia, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milano, Italy
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195
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Alhashem MH, Alabidi A, Aly MG. The Bethesda System for Reporting Thyroid Cytopathology: A Retrospective Review of its Diagnostic Utility at Johns Hopkins Aramco Healthcare, Saudi Arabia. Am J Otolaryngol 2021; 42:103088. [PMID: 34090018 DOI: 10.1016/j.amjoto.2021.103088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Fine needle aspiration (FNA) is the gold standard for assessment of thyroid nodules, with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) used to predict the malignancy risk of these nodules. Our aim was to evaluate the diagnostic utility of the TBSRTC for a Saudi population, by comparing the malignancy risk based on histopathology to FNA-based diagnosis of each of the TBSRTC categories and to previously published malignancy risk in other population. MATERIALS AND METHODS This was a retrospective study of the data of 241 patients who underwent FNA assessment of thyroid nodules and surgical resection with histopathology at John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, between January 2016 and December 2019. RESULTS The malignancy risk for each of the TBSRTC categories was as follows: non-diagnostic, 25%, benign; 5.74%; atypia of undetermined significance, 37%; suspicious for follicular neoplasm, 38%; suspicious for malignancy, 100%; and malignant, 95%. Our finding were comparable to previously published malignancy risks, except for a higher rate of malignancy in the benign category at 18% compared to 0-3%. CONCLUSION Our findings validate the diagnostic reproducibility of the TBSRTC for a Saudi population, with the risk of malignancy confirmed by histopathological assessment being consistent with those previously reported for other populations.
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Wu SC, Chi SY, Rau CS, Kuo PJ, Huang LH, Wu YC, Wu CJ, Lin HP, Hsieh CH. Identification of circulating biomarkers for differentiating patients with papillary thyroid cancers from benign thyroid tumors. J Endocrinol Invest 2021; 44:2375-2386. [PMID: 33646556 DOI: 10.1007/s40618-021-01543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to identify the potential circulating biomarkers of protein, mRNAs, and long non-coding RNAs (lncRNAs) to differentiate the papillary thyroid cancers from benign thyroid tumors. METHODS The study population of 100 patients was classified into identification (10 patients with papillary thyroid cancers and 10 patients with benign thyroid tumors) and validation groups (45 patients with papillary thyroid cancers and 35 patients with benign thyroid tumors). The Sengenics Immunome Protein Array-combined data mining approach using the Open Targets Platform was used to identify the putative protein biomarkers, and their expression validated using the enzyme-linked immunosorbent assay. Next-generation sequencing by Illumina HiSeq was used for the detection of dysregulated mRNAs and lncRNAs. The website Timer v2.0 helped identify the putative mRNA biomarkers, which were significantly over-expressed in papillary thyroid cancers than in adjacent normal thyroid tissue. The mRNA and lncRNA biomarker expression was validated by a real-time polymerase chain reaction. RESULTS Although putative protein and mRNA biomarkers have been identified, their serum expression could not be confirmed in the validation cohorts. In addition, seven lncRNAs (TCONS_00516490, TCONS_00336559, TCONS_00311568, TCONS_00321917, TCONS_00336522, TCONS_00282483, and TCONS_00494326) were identified and validated as significantly downregulated in patients with papillary thyroid cancers compared to those with benign thyroid tumors. These seven lncRNAs showed moderate accuracy based on the area under the curve (AUC = 0.736) of receiver operating characteristic in predicting the occurrence of papillary thyroid cancers. CONCLUSIONS We identified seven downregulated circulating lncRNAs with the potential for predicting the occurrence of papillary thyroid cancers.
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Affiliation(s)
- S-C Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - S-Y Chi
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - C-S Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - P-J Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - L-H Huang
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - Y-C Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - C-J Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - H-P Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - C-H Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan.
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Goulart APFE, Batista ERM, Figueira MG, Magalhães PKR, Maciel LMZ. Evaluation of thyroid nodules in the Brazilian Public Health Care System, Supplementary Health System, and Private Health System in the northeastern region of the State of São Paulo. Arch Endocrinol Metab 2021; 64:779-786. [PMID: 33049130 PMCID: PMC10528606 DOI: 10.20945/2359-3997000000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To obtain data about the evaluation of thyroid nodules (TNs) in the northeastern of the State of São Paulo, compared by health care type, and measure the performance of cytology as a screening test for thyroid cancer (TC). METHODS We collected data of 597 patients treated in the Brazilian public health care system (SUS), supplementary health (SH) and in private health system (PHS) in 2014. A total of 803 TNs were aspirated, and 125 patients underwent surgery. RESULTS The distribution of all cytologic results according to the Bethesda system was: I, 135 (16.8%); II, 475 (59.2%); III, 107 (13.3%); IV, 32 (4.0%); V, 20 (2.5%); VI, 34 (4.2%). The time between cytologic analysis and surgery was longer in the SUS than in the SH for TNs in general (p < 0.001) and for TNs with Bethesda V and VI cytology (p = 0.01). The sizes of the TNs and resected malignant TNs was larger in the SUS than in the SH (p = 0.001 and p = 0.02, respectively). The number of PHS surgeries was too small and was not compared. The prevalence of TC was 9.2% and 23.6% of them were treated in the SUS. Cytology showed a 93.6% sensitivity, 95.8% specificity, and 94.7% accuracy when Bethesda III and IV were excluded. CONCLUSION Cytology was a good screening test for TC categories Bethesda II, V, and VI. The differences between the SUS and SH indicate a need for improved access to consultations and specialized tests in the SUS.
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Affiliation(s)
- Ana Paula Figueiredo Engler Goulart
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | | | - Patrícia Künzle Ribeiro Magalhães
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Léa Maria Zanini Maciel
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
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199
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Danno H, Nishihara E, Kousaka K, Nakamura T, Kasahara T, Kudo T, Ito M, Fukata S, Nishikawa M, Miyauchi A. Prevalence and Treatment Outcomes of Marine-Lenhart Syndrome in Japan. Eur Thyroid J 2021; 10:461-467. [PMID: 34950599 PMCID: PMC8647058 DOI: 10.1159/000510312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Marine-Lenhart syndrome (MLS) is now understood to be a combination of Graves' disease and autonomously functioning thyroid nodule(s) (AFTNs). The prevalence of the syndrome and suitable treatments for those living in iodine-sufficient areas are uncertain. OBJECTIVES We aimed to investigate the prevalence, treatment, and prognosis of MLS in Japan, an iodine-sufficient area. METHODS This study involved patients who visited our hospital between February 2005 and August 2019. Among patients with both thyrotoxicosis and thyroid nodule(s) larger than 10 mm, MLS and isolated AFTNs were diagnosed based on serum thyroid-stimulating hormone receptor antibody levels and scintigraphy using radioiodine or technetium-99m and thyroid uptake. RESULTS Twenty-two patients were found to have MLS, compared to 372 with isolated AFTNs and 8,343 with Graves' disease, during the period. Therefore, the rate of MLS cases was 0.26% among all patients with Graves' disease (22/8,343). Treatments and outcomes were assessed for cases of MLS (n = 18) and isolated AFTNs (n = 269). Antithyroid drugs (ATDs) were withdrawn in 27.8% of cases in the MLS group and 10.3% in the isolated AFTN group. There was no significant difference in the clinical outcome after ATD withdrawal between the 2 groups. However, the rate of hypothyroidism after radioactive iodine (RAI) administration was significantly higher in the MLS group than in the isolated AFTN group (42.9 vs. 9.0%, p = 0.005) despite similar doses of RAI. CONCLUSIONS The prevalence of MLS among patients with Graves' disease was 0.26% in Japan. RAI therapy induces hypothyroidism more frequently than in those with AFTNs probably because RAI is taken up in the surrounding Graves' tissues.
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Affiliation(s)
- Hirosuke Danno
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
- *Hirosuke Danno, Center for Excellence in Thyroid Care, Kuma Hospital, 8-2-35, Shimoyamate-Dori, Chuo-Ku, Kobe-City Hyogo 650-0011 (Japan),
| | - Eijun Nishihara
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Kazuyoshi Kousaka
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Tomohiko Nakamura
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Toshihiko Kasahara
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Mitsuru Ito
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Shuji Fukata
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Mitsushige Nishikawa
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Division of Surgery and Director, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
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Abstract
The relationship between insulin resistance and thyroid nodules is not clearly understood. The purpose of this study is to investigate the relationship between insülin resistance and thyroid nodules in non-diabetic patients. 410 patients who applied to the Internal Medicine outpatient clinic from June 2018 to July 2019 were reviewed retrospectively. A total of 216 non-diabetic patients were divided into two groups. The relationship of 105 patients with thyroid nodules and 110 patients without thyroid nodules with insulin resistance was investigated. Homeostasis model assessment of insulin resistance value, serum triglycerides and total cholesterol level, and the ratio of women were higher in the group with thyroid nodules (p < 0.05). There was a positive and significant relationship between homeostasis model assessment of insulin resistance value and thyroid nodules (r + 0.29, p < 0.05). In non-diabetic thyroid nodule patients, a significant relationship was detected between nodule formation and insulin resistance. However, these data must be confirmed by other studies in the future.
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Affiliation(s)
- Sibel Demiral Sezer
- Internal Medicine, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey.
| | - Elçin Erdoğan Yücel
- Internal Medicine, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
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